Responsible for all facets of medical billing coding audits of physicians and Advanced Practice Providers (APP). Assists Billing Specialists, Coders, and Patient Accounts Specialists in ongoing operations of the Billing Department to achieve patient care and financial goals. Provides cross coverage to ensure efficient operations and maximum patient satisfaction.
Maintains credentialing files for Physicians and APPs across multiple health systems and insurance payors. Assists with maintaining professional licensure and CME requirements.
Organizes coding, insurance carriers, managed care networks, and credentialing information.
Reviews physician coding at charge entry to ensure compliance with Medicare guidelines for accurate and timely reimbursement.
Conducts quarterly audits and provides feedback on charting and documentation improvements. Reports findings to Financial Operations Manager and COO.
Manages coding sets within Athena for services rendered, updating as needed.
Inputs charges for physician professional services, office and hospital charges following practice protocols with emphasis on accuracy.
Posts payments and adjustments in the practice management system accurately to ensure profitability and patient satisfaction.
Files all charge, payment, and adjustment batches appropriately for reference.
Provides customer service regarding patient accounts by telephone and in office promptly.
Verifies demographic and insurance information to ensure reimbursement.
Follows up on returned claims, denials, reconciliations, and rebills promptly to maximize reimbursement.
Submits insurance claims electronically daily.
Processes refunds in accordance with protocols.
Proficient with medical practice management systems including registration, charge entry, insurance processing, collections, reports, and ledger inquiries.
Maintains an organized, efficient, and professional work environment adhering to OSHA, HIPAA, and Medicare compliance.
Other duties as assigned.
Minimum 5 years of experience preferably in a surgical subspecialty private practice. CPC certification required. Ability to read and interpret procedural documents, write reports, and communicate effectively. Mathematical skills required for unit calculations. Problem-solving skills for non-standard situations. Experience with Windows environment, spreadsheet, word processing, and electronic medical record systems. Knowledge of medical terminology, processes, procedures, lab and radiology tests, medications is helpful. Ability to handle patients professionally and efficiently.
Location
Delaware, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
No
Posted
3 weeks ago