SUMMARY:
The Medical Biller/Medical Coder (MBMC) assures all established billing guidelines, systems applications, workflows, and process requirements are being met daily, in order to ensure timely filling of claims, Payer denial reductions, and optimal reimbursement. The MBMC will be responsible for submitting Government and Commercial Insurance claims, validating coding accuracy, reviewing and capturing charges, and correcting errors. The MBMC will also be responsible for assisting patients with insurance related inquiries and account balance discrepancies. The MBMC will maintain positive working relationships with co-workers, patients within the Provider services community and public entities, by utilizing professional customer service skills. The MBMC will positively impact the Revenue Cycle by contributing to the organization’s efforts to meet monthly A/R performance measures and productivity goals, and operating according to industry benchmarks.
RESPONSIBILITIES:
1. Physician coding review; verifying patient medical history and validating procedures.
2. Charge capture; primary and secondary claims submission.
3. Front-end rejections’ resolution and clearinghouse account management.
4. Payer denials analytics, resolution and reduction management.
5. Insurance claims follow-up, i.e. Medicaid, Medicare and Commercial Payers.
6. Private-Pay patients’ itemized billing statements, payment arrangements, past due balances, bankruptcies, and legal aid account reconciliation.
7. Point of Service (POS), Payment on Account (POA), and account receivables reconciliations.
8. Contract invoicing and cash receipts variance reconciliation.
9. Generate monthly claim status reports.
10. Communicates professionally and effectively while adhering to the privacy policy and compliance guidelines with: Physicians, Mid-Level Providers, Attorneys, Insurance Payer Representatives, Front and Back Office staff, contracted facilities and patients.
11. Communicates verbally and in writing regarding account inquires and/or balance discrepancies, billing and claim balance resolution, procedural coding, invoices and payments.
12. Participates in on/off-site webinars, conference calls, and training sessions as assigned by management, i.e., CMS Workshops, Insurance Provider Network sessions, Coding conferences.
13. Attends Billing staff meetings and/or huddles as assigned.
14. Cross-train as assigned to ensure department workflows and process are adhered to during the absence of additional support staff.
15. Perform other duties as assigned by the Oconee Valley Healthcare Administrative Staff.
EDUCATION, ESSENTIAL SKILLS AND EXPERIENCE:
- A high school diploma or GED with 2 (two) years equivalent experience in Medical Billing and MedicalCoding in a physician or hospital billing revenue cycle or central business office utilizing CPT, HCPCSLevel II, Category II Coding; ICD-9 and ICD-10-CM Coding; and CMS national billing guideline.
- Advanced knowledge of third-party insurance, and familiarity with insurance plan types: HMO, PPO,POS, Indemnity Plans, Workman’s Compensation, and Veterans Affairs Healthcare Administration filing standards.
- Possess thorough knowledge of Medicaid and Medicare Programs’ timely filing guidelines, and rules and regulations, particularly as it relates to CPT, Category II & III, HCPCS Level II, and ICD-10 coding and reimbursement for an FQHC.
- Possess thorough knowledge of Medicare Fraud and Abuse regulations.
- Possess thorough knowledge of HIPAA regulations and guidelines.
- Demonstrated knowledge of any of the following Practice Management Systems: EClinicalWorks, Athena Health, Epic, or GE Centricity.
- Demonstrated knowledge of any of the following Revenue Cycle Management Solutions: Availity, Emdeon (Change Healthcare), Gateway-TriZetto, ESolutions Analyzer, or Medicare Easy Print.
- Demonstrated knowledge of MS Office Suites Applications: Excel, Outlook, PowerPoint and Word
- Attention to details with strong organizational skills.
- Oral and written communication skills.
Requires sitting or standing for long periods of time while working in an office environment. Must have ability to perform general office administrative activities; copying, faxing, filing, answering phones and voicemails daily. Must be able to stoop, kneel, bend at the waist, reach and/or extend; as well as, lift and move up to 25 pounds occasionally. Working under sensitive time-lines and use of the telephone required. Manual dexterity required for use of calculator and computer keyboard and other office machines. Hearing and vision corrected to normal range. Must be a team player and possess excellent customer service skills.
Job Type: Full-time
Pay: $14.00 - $20.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Employee discount
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
Education:
- High school or equivalent (Required)
Experience:
- Medical billing: 1 year (Preferred)
Work Location: In person