Address
Form of workCertified Billing & Coding Specialist
SUMMARY: Requires knowledge of ICD-10 coding, accurate typing skills, computer knowledge, prior utilization of an Electronic Medical Record system, knowledge of medical terminology, and the ability to communicate effectively with physicians, co-workers, insurance plan representatives and attorneys.
DUTIES AND RESPONSIBILITIES:
- Identify billing errors for corrections and resubmit claims to insurance carriers.
- Follow up on payment errors, low reimbursement, and denials.
- Compile, code, and submit patient insurance claims to insurance companies as well as follow up on all claims from charge entry through resolution.
- Review insurance EOB's and initiate appeals as necessary.
- Respond and appeal to medical necessity denials.
- Updating system errors, noting system, researching insurance guidelines.
- Follow protocol to determine best course of action to follow up on open receivables.
- Research root issue of denial. Apply knowledge of payer policies to pursue proper course of appeal or follow up to obtain payment.
- Review account history for continuous follow up.
- Contact insurance companies and/or patient/guarantor through phone contact, correspondence, online portals and other approved means to obtain status of outstanding claims and submitted appeals.
- Documents clearly in billing system the claim issue and course of action taken on every account worked. Documentation and action must be clearly noted for future follow up and review.
- Escalate issues and problems to supervisor as appropriate.
- Identify trends or patters of persistent problems.
- Perform charge corrections based on payer and institutional policies.
- Negotiate out-of-network reimbursement, based on determined criteria for max reimbursement.
- Perform other related duties as assigned by management.
QUALIFICATIONS:
- High school diploma or equivalent.
- Certified Billing and Coding Specialist Certification required.
- Certified Professional Coder Certification (CPC) from AAPC required.
- Three to five years experience with ICD-10, insurance collections and processing out-of-network claims.
- Excellent written and oral communication skills.
- 10-key by touch; keyboarding speed of at least 50 wpm.
- Knowledge of medical billing terminology.
- Ability to perform diversified clerical functions and basic accounting procedures.
- Ability to effectively communicate with people at all levels and from various backgrounds.
- Commitment to excellence and high standards.
- Strong organizational, problem-solving, and analytical skills.
- Ability to manage priorities and workflow.
- Acute attention to detail.
- Ability to work independently and as a member of various teams and committees.
- Proven ability to handle multiple projects and meet deadlines
- Bilingual skills a plus.
BENEFITS:
- Competitive salary and benefits package
- Health, dental, and vision insurance
- Retirement Plan
- Employee Assistance Program
- Paid Time Off
- Opportunities for professional development and growth
- Collaborative and supportive work environment
Progressive Spine & Orthopaedics is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
PI948cf390c981-25405-34119400
