Medical PA Billing Specialist - Katy Trail Community Health

Work cooperatively with Clinic providers and support personnel to accomplish all goals and objectives of Katy Trail Community Health. Medical Billing Assistant/Authorization specialist is responsible for handling all types of insurance claims, including private, Medicare and Medicaid to include obtaining prior authorization for in house procedures. They are responsible for insurance collections and making sure claims are processed in a timely, accurate, and compliant manner to ensure the organization gets properly reimbursed for services provided. This includes working on follow-ups, denials and refunds.

POSITION RESPONSIBILITIES:
I. To assure all pre-authorizations have been approved with the proper procedure code prior to services being rendered for in house procedures.
• Assist in educating and acts as a resource to clinicians and support staff regarding authorizations.
• Contacts providers with authorization denial and appeals process information.
• Review provider schedules to identify possible procedures that may need a prior authorization.

II. Provide a quality review and analysis of a wide range of patient medical record to ensure accuracy of coding and maintain records with accepted medical and legal standards, including Fraud, Waste and Abuse compliance.
• Assist in identifying encounter charges that can be made appropriate by billing and provider.
• Communicate with providers and support staff as necessary to ensure claims may be accurately prepared.
• Assist providers and staff with any coding issues and/or questions

III. Provide accurate review of medical records to fully optimize all professional services documented for billing to maximize service reimbursement.
• Interpret patient's medical records and visit notes daily to assure the correct assignment of diagnosis and procedure codes for visits before charges are posted.
• Ensure outgoing claims are appropriate and complete for successful third party resolution.
• Input provider numbers and needed information in Emomed to maintain Medicaid billing and submit same information to clearing house for other third party billing.

III. Support organizational financial sustainability by performing accurate and timely accounts receivable functions.
• File claims, both electronic and paper, to all third party payers for medical and dental (as requested for dental).
• Submit patient bills for payment to private pay patients (including uninsured).
• Post payments/ remittances to patient accounts, paying close attention to necessary adjustments & asking appropriate notations.
• Review denied insurance claims, correct and resubmits as necessary, forwarding to secondary insurance, or converting to self-pay with appropriate documentation for medical.Keep pending and aging insurance claims current.
• Process collection letters as scheduled and reviewing accounts for bad debt processing and running credit balance reports and requesting refunds for patients as appropriate.
• Assist patients and employees with resolution of account balance problems or discrepancies.
• Review and analyze Credit Balance Report monthly and submit a request for refunds due to patient.
• Review and analyze Insurance Payor accounts receivable report monthly and follow-up on unpaid claims.
Maintain industry knowledge to boost operational efficiency and organizational learning.
• Obtain and maintain knowledge of acceptable coding practices and requirements.
• Maintain current knowledge of third party programs and requirements.
• Ensure all billing practices meet legal, federal, and insurance regulations.
• Participant in ongoing quality assurance and quality improvement activities both at the department and organizational level.
• Maintain current knowledge of ICD-10 and CPT coding as well as insurance payor information and requirements.
• Attend appropriate training, including travel to required education seminars related to job description.
Other duties may be assigned, as needed, to achieve organizational and programmatic goals to increase operational effectiveness.

POSITION REQUIREMENTS:
• Minimum of high school diploma or equivalent, some college coursework and/or other specialized and relatable training preferred.
• Working knowledge of coding & billing functions of third party payer system, including Medicare, Medicaid, and commercial insurance.
• CPC or other billing certification preferred
• Current knowledge of ICD-10 diagnostic and CPT-5 procedural coding applications.
• Ability to accurately record and transmit detailed information.
• Ability to interpret and comply with applicable regulations.
• Demonstrated computer skills and knowledge pertaining to the usage of electronic medical record and practice management systems as well as Microsoft Office applications such as Outlook, Excel and Word.
• Effective organizational skills and time management skills.
• Effective interpersonal and communication skills, both in verbal and written form.
• Outstanding customer service mindset.
• Experience with office procedures and equipment (copier, fax, telephone system, etc.)
• Ability to see, hear, read, write, kneel, stand, sit and lift up to 35 lbs.without device assistance
• Ability to manage oneself in pressure situations.