AR Billing and Coding Specialist

Statement of Purpose:  This position is accountable for all steps in the billing & coding process including processing medical, behavioral health and psych claim information through data-entry in the EMR, and researching and correcting data entry errors using eClinicalWorks. This position uses knowledge of CPT and ICD-10 codes to determine the appropriate order and combination of alpha, numeric or symbolic data to ensure accuracy in entering medical claim information. This position is in a primary care and behavioral health social service setting with specialized LGBTQ+ care and services.

Primary Tasks/Responsibilities:

• Review an average 125 Coding claims per day
• Process an average of 125 Aging claims daily including follow up accounts.
• Patient collections and outstanding balance – work at least 50 patient accounts per week.
• Review claims data to ensure the insurance sequence is correct for billing (primary, secondary, etc.)
• Submitting claims for services rendered to insurance companies in a timely fashion
• Working directly with the payer, the patient, clearinghouse and clinic staff to get claims processed and paid
• Assisting patient with updating denials for coordination of benefits with the payer.
• Work closely with Third Party Liability (TPL).
• Know and understand CMS regulations for billing & coding.
• Reviewing and appealing denied and unpaid claims to resolve denial instances for billing and coding issues.
• Achieve maximum reimbursement for services rendered
• Understanding of the charge masters and sequence of payments
• Monitoring and updating patient outstanding AR balances
• Recognize patterns, trends and systematic errors for corrections in coding and billing queues including denials
• Scrubbing of claims, timely follow-up for missing required items
• Working Aging Buckets through work queues for accuracy and timely payment.
• Answering questions for patients, providers and third-party insurers about billing, coding and outstanding balances.
• Reviewing patient statements for accuracy and completeness and obtain any missing information
• Handling collections and unpaid accounts by establishing payment arrangements with patients, monitoring payments, and following up with patients if or when there is a lapse in payment.
• Other duties as necessary including special projects

Education/Professional:

• Minimum of 2 years of experience as medical biller or denial specialist in primary care and behavioral health setting highly preferred.
• Certified Coding Certification required.
• Experience working with multiple third-party payers including Medicaid, Medicare, Managed Care, HMO/PPOs, preferred.

 Knowledge, Skills and Competencies Required:

• Strong knowledge of and able to easily navigate Medicaid, Medicare, HMOs, and private payer systems
• Knowledge of EMR systems, preferably with eClinicalWorks.
• Microsoft suite and data systems proficiency, including Electronic Medical Records.
• Ability to effectively communicate both written and verbally.
• Ability to effectively utilize problem-solving and decision-making techniques.
• Ability to make effective judgments and decisions based on objective criteria.
• Attentive to detail and strong organizational skills.
• Ability to tactfully interact with diverse personalities.
• High comfort working in a busy environment with changing priorities.

Requirements:

• Must possess and maintain valid Florida driver’s license and proof of insurance
• Must have reliable and accessible auto vehicle.
• Must pass necessary fingerprinting, Level II background checks and employment eligibility verification through the U. S. Department of Homeland Security’s E-Verify system, https://e-verify.uscis.gov/emp.