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DATE ADDED: Thu 11/10/2018

Medical Biller/Coder

Stamford, USA
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COMPANY: COMPANY CONFIDENTIAL

Job Description

JOB SUMMARY:

The Revenue Cycle Specialist is responsible for supporting either the Accounts Receivable team or the Customer Service and Cash Applications team with a focus on one of the following groupings:

- Denial Resolution: researching, resolving, and resubmitting denied claims; taking timely and routine action to collect unpaid claims; and interpreting various forms of explanations of benefits (EOBs) from insurance carriers

- Customer Service: providing quality assistance patients to resolve any and all billing-related questions; and ensuring proper demographic and insurance information for those patients served

- Cash Applications: entering patient and insurance payments, contractual allowances, denials, correspondence, and other adjustments into the medical group’s practice management system; balancing and reconciling posting batches; and participating in month-end close

MAJOR ACCOUNTABILITY/CRITICAL RESPONSIBILITIES:

Denial Resolution Focus:

· Understands and interprets insurance Explanations of Benefits (EOBs), knowing when and how to ensure that maximum payment has been received.

· Researches and resolves rejected, incorrectly paid, and denied claims within an established time frame.

· Researches and resolves unpaid accounts receivable and makes any corrections in medical group’s practice management system necessary to ensure maximum reimbursement for all services rendered.

· Resubmits claim forms as appropriate.

· Professionally responds to all billing-related inquiries from patients, staff, and payers in a timely manner.

· Utilizes available resources to identify reasons for payment discrepancies.

· Keeps management informed of changes in billing requirements and rejection or denial codes as they pertain to claim processing and coding.

· Accurately documents patient accounts of all actions taken.

· Communicates with clinic management and staff regarding insurance carrier contractual and regulatory requirements.

· Educates clinic management and staff regarding changes to insurance and regulatory requirements.

· Actively participates in practice management and payer meetings.

Customer Service Focus:

· Greets in-bound calls from patients.

· Responds professionally to all billing-related questions from patients.

· Returns all phone messages within 24 hours of receipt.

· Reviews patient account data when interacting with patients to ensure that accurate information regarding patients’ insurance and demographic information are correctly reflected on the patient’s account.

· Updates insurance and demographic information as necessary on patient accounts.

· Resubmits claim forms as appropriate.

· Initiates requests for refunds to either patients or insurance companies.

· Accurately documents patient accounts of all actions taken.

· Identifies past due accounts and submits them to Collector for assignment to outside collection agency.

· Establishes payment arrangements for patients on past-due accounts and when appropriate in accordance with policy, submits them to management for approval.

Cash Applications Focus:

· Effectively posts insurance/patient payments, remittances, and correspondence to respective patient invoices, and when appropriate, transfers remaining balances to the next responsible parties.

· Understands and interprets insurance Explanations of Benefits (EOBs).

· Processes and posts electronic remittance advices.

· Balances and reconciles each batch, using control mechanisms in accordance with policy.

· Documents and notes all actions taken regarding patient accounts.

· Responds professionally to all billing/cash-related calls and questions from internal customers within 3 business days.

· Coordinates account resolution with accounts receivable team if and when appropriate.

Relevant to Each Focus:

· Accurately documents patient accounts of all actions taken.

· Establishes and maintains a professional relationship with all staff in order to resolve problems and increase knowledge of account management.

· Maintains standards set by management.

· Apprises management of concerns as appropriate.

· Informs management, as appropriate, regarding backlogs and time available for additional tasks.

· As necessary, negotiates a work improvement plan with management to raise work quality and quantity to standards.

· Completes additional projects and duties as assigned.

QUALIFICATIONS/REQUIREMENTS:

· Associate’s degree or medical billing certification preferred. CPC preferred.

· 3+ years of experience working in a multi-specialty group practice, healthcare system with an ambulatory focus, or academic medical center.

· 3+ years of experience working with a medical office/hospital accounts receivable system.

· Extensive knowledge of insurance payer reimbursement, collection practices, and accounts receivable follow-up.

· Demonstrates overall knowledge of claims processing for various insurances, including private and governed.

· Comprehensive knowledge of ICD-10, CPT, and HCPCS coding.

· Moderate to advanced computer skills, including Microsoft Windows programs.

· Moderate to advanced keyboard skills with high accuracy rate.

· Ability to communicate effectively in written and spoken English.

· Demonstrates effective communication and interpersonal skills with a diverse population.

· Ability to organize and prioritize workload to manage multiple tasks and meet deadlines.

· The ability to work with individuals at all organizational levels, particularly peers, team members, other departments, patients, and the community is required.

· Demonstrates the ability to carry out assignments independently, work from procedures, and exercise good judgment.

· Demonstrates the ability to maintain the confidentiality of all records.


Role: Medical Biller/Coder
Job Type:
Location: Stamford,

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