Certified Billing & Coding Specialist

Certified 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.

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