Procedural Billing Specialist I - Tech Observer

Job Summary

Performs specialized coding services for inpatient and outpatient medical office visits. Reviews physician coding and provides updates.

• Provides comprehensive financial counseling to patients. Responsible for setting patient expectations, discussion of financial options, payment plans, one-time settlements, and resolution of unpaid balances.

• Discusses with patients the details concerning their insurance coverage and financial implications of out-of-network benefits, including pre-determination of benefits, appeals, and/or pre-certification limitations.

• Develops and manages fee schedules for self-pay patients.

• Processes Worker's Compensation claims and addresses/resolves all discrepancies.

• Conducts specialized negotiations with insurance companies. Brokers and negotiates with insurance carriers. Establishes a network of key representatives within the insurance pre-certification units to establish open lines of communication for future service negotiation.

• Verifies insurance and registration data for scheduled office, outpatient, and inpatient procedures. Reviews encounter forms for accuracy. Responsible for obtaining pre-certifications for scheduled admissions.

• Enters office, inpatient, and/or outpatient charges with accurate data entry of codes.

• Posts all payments in IDX. Runs and works missing charges, edits, denials list, and processes appeals. Posts denials in IDX on a timely basis.

• Provides comprehensive denial management to facilitate cash flow. Tracks, quantifies, and reports on denied claims.

• Directs and assists with responses to problems or questions regarding benefit eligibility and reimbursement procedures.

• Researches unidentified or misdirected payments.

• Works credit balance report to ensure adherence to government regulations/guidelines.

• Analyzes claims system reports to ensure underpayments are correctly identified and collected from key carriers. Reviews and resolves billing issues and provides recommendations.

• Identifies and resolves credentialing issues for department physicians.

• Maintains a thorough understanding of medical terminology through participation in continuing education programs to effectively apply ICD-10-CM/PCS, CPT, and HCPCS coding guidelines to inpatient and outpatient diagnoses and procedures.

• Meets with practice management, leadership, and/or physicians on a scheduled basis to review Accounts Receivable and current billing concerns.

• Mentors less experienced billing staff and assists Billing Manager/Revenue Cycle Manager in staff training.

Required Skills & Experience

• Excellent organizational skills.

• Excellent communication and customer service skills.

• Knowledge of medical terminology and anatomy.

• Strong attention to detail and ability to multitask.

• Excellent calculation, verbal, and communication skills.

• Strong ability in analysis and research.