Description

This position assigns diagnostic and procedural codes using ICD-10-CM and ICD-10-CPT on all medical record types at an advanced level to ensure proper reimbursement and accurate data base information in a multi clinic setting.
Duties and Responsibilities:
• Design and implement processes surrounding proper coding of medical and behavioral health claims.
• Reviews diagnosis and procedure coding within eClinicalWorks on a regular basis, including the establishment of a monthly audit protocol to ensure appropriate coding for optimal billing
• Enters information necessary for insurance claims such as patient, insurance ID, diagnosis and treatment codes and modifiers, and provider information. Insures claim information is complete and accurate.
• Submits insurance claims to clearinghouse or individual insurance companies electronically.
• Answer patient questions on patient responsible portions, copays, deductibles, write-off’s, etc. Resolves patient complaints or explains why certain services are not covered. Follow up with third-party insurance carriers on unpaid claims till claims are paid or only self-pay balance remains.
• Follows up with insurance company on unpaid or rejected claims. Resolves issue and re-submits claims.
• Prepares appeal letters to insurance carrier when not in agreement with claim denial. Collect necessary information to accompany appeal.
• Prepares patient statements for charges not covered by insurance. Insures statements are mailed on a regular basis.
• May work with patients to establish payment plan for past due accounts in accordance with provider policies.
• Provides necessary information to collection agencies for delinquent or past due accounts.
• Posts insurance and patient payments using medical claim billing software.
• Secures needed medical documentation required or requested by third party insurance. For patients with coverage by more than one insurer, prepares and submits secondary claims upon processing by primary insurer.
• Follows HIPAA guidelines in handling patient information.
• May periodically create insurance or patient aging reports using the medical practice billing software. These reports are used to identify unpaid insurance claims or patient accounts and to provide support for financial reporting
• Understands managed care authorizations and limits to coverage such as the number of visits. This is encountered often when billing for specialties.
• Coordinate patient information collection related to Sliding Scale Program and Payment Plans
• May have to verify patient benefits eligibility and coverage.
• Stays current with legal and regulatory changes, and local and national trends, in coding.
• Keep abreast of changes in third party reimbursement procedures.
• Collects and submits credentialing information for all providers and submits this information to the appropriate insurance carriers.
• Attend departmental and other meetings as assigned by supervisor.
• Assisting with the creation of Fee Schedules to be submitted to the Board of Directors for approval. Once approved, new fees are edited in eClinicalWorks.
• Other duties as assigned


Knowledge, Skills, and Abilities
• Knowledge of HIPAA confidentiality requirements, maintains strictest confidentiality.
• Knowledge of EMR software, Excel, Word, healthcare databases and clearinghouse software.
• Knowledge of CPT, HCPCS, ICD-9, ICD-10 coding protocols, Medicaid, third party and Medicare billing and coding.
• Knowledge of regulatory standards appropriate for position.
• Ability to understand and apply applicable rules, regulations, policies and procedures.
• Ability to communicate effectively.
• Ability to establish and maintain effective working relationships with clinicians and patients.

Software Access
Microsoft Office
eClinialWorks
Acrobat Pro
Minimum Qualifications

A High School Diploma and three to five years’ experience in insurance billing (CBT Codes). Completion of accredited medical records program i.e., Certified Coding Specialist, Certified Professional Coder or AAPC preferred.