Procedural Billing Specialist I

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Job description

Job Summary

Performs specialized coding services for inpatient and outpatient medical office visits. Reviews physician coding and provides updates.

Provides comprehensive financial counseling to patients. Responsible for setting patient expectations, discussion of financial options, payment plans, one-time settlements, and resolution of unpaid balances.

Discusses with patients the details concerning their insurance coverage and financial implications of out-of-network benefits, including pre-determination of benefits, appeals, and/or pre-certification limitations.

Develops and manages fee schedules for self-pay patients.

Processes Worker's Compensation claims and addresses/resolves all discrepancies.

Conducts specialized negotiations with insurance companies. Brokers and negotiates with insurance carriers. Establishes a network of key representatives within the insurance pre-certification units to establish open lines of communication for future service negotiation.

Verifies insurance and registration data for scheduled office, outpatient, and inpatient procedures. Reviews encounter forms for accuracy. Responsible for obtaining pre-certifications for scheduled admissions.

Enters office, inpatient, and/or outpatient charges with accurate data entry of codes.

Posts all payments in IDX. Runs and works missing charges, edits, denials list, and processes appeals. Posts denials in IDX on a timely basis.

Provides comprehensive denial management to facilitate cash flow. Tracks, quantifies, and reports on denied claims.

Directs and assists with responses to problems or questions regarding benefit eligibility and reimbursement procedures.

Researches unidentified or misdirected payments.

Works credit balance report to ensure adherence to government regulations/guidelines.

Analyzes claims system reports to ensure underpayments are correctly identified and collected from key carriers. Reviews and resolves billing issues and provides recommendations.

Identifies and resolves credentialing issues for department physicians.

Maintains a thorough understanding of medical terminology through participation in continuing education programs to effectively apply ICD-10-CM/PCS, CPT, and HCPCS coding guidelines to inpatient and outpatient diagnoses and procedures.

Meets with practice management, leadership, and/or physicians on a scheduled basis to review Accounts Receivable and current billing concerns.

Mentors less experienced billing staff and assists Billing Manager/Revenue Cycle Manager in staff training.

Required Skills & Experience

Excellent organizational skills.

Excellent communication and customer service skills.

Knowledge of medical terminology and anatomy.

Strong attention to detail and ability to multitask.

Excellent calculation, verbal, and communication skills.

Strong ability in analysis and research.

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