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Medical Coding & Client Financial Services Specialist

SUMMARY

The Medical Coding & Client Financial Services Specialist is primarily responsible for Insurance and Client account follow up, billing, collection, and resolution of insurance reimbursement, as well as minimizing loss prevention of the Accounts Receivable. Additional responsibilities may include providing back up for Benefits Specialists in verifying client eligibility, benefits, and obtaining authorizations for new and existing clientele to ensure future reimbursement.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following

Certified Coder Responsibilities:

  • Assigns required Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), International Classification of Diseases, Clinical Modification (ICD-10-CM)
  • Advises and trains providers and staff on medical coding.
  • Reads and analyzes patient records.
  • Audits and determines the correct codes for patient/client records
  • Using codes to bill insurance providers
  • Performs chart audits.
  • Ensures compliance with medical coding policies and guidelines.

Billing Responsibilities:

  • Accounts Receivable – the Pursuit of any unresolved Medicaid, Managed Medicaid, Medicare, Commercial and SASS claims
  • Focuses on collection and reconciliation of insurance reimbursements, as well as minimizing loss prevention of the Accounts Receivable.
  • Initiates claim status inquiries to insurance companies, clients, and clinical staff for the purpose of final resolution of claims
  • Initiates inquiries regarding insurance coverage and authorization issues to Commercial and Medicaid entities to help resolve any coverage and authorization denials.
  • Focuses on insurance explanation of benefits (EOB) differences and insurance reimbursement
  • Maintain the accuracy of Client Fees for the managed care and commercial client population in conjunction with insurance reimbursement and EOBs
  • Processes and Posts insurance payments, review and resolution of contractual reimbursement
  • Troubleshooting Billing issues (eligibility, patient responsibility, contractual reimbursement, etc.)
  • Phone calls / online checks to various payers to check status and/or eligibility and benefits
  • Obtain and follow-up on pre-certification for the clinical staff for treatment, which included processing authorization requests for all Payers (ex. Medicaid, Managed Medicaid, Commercial payers) to ensure future reimbursement.
  • Monitoring CPT/HCPCS code changes
  • Data Entry of claims, payments, authorizations, coverage, and client fees into agency database
  • Answers and troubleshoots client questions from in-bound patient Billing issues – identifies and resolves patient billing complaints
  • Acts as backup for Benefits Specialists when necessary
  • Participate in regularly scheduled billing team and CFS department meetings
  • Minimal back-up with Front Desk Reception duties
  • General office tasks as needed
  • Other duties as assigned.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and or ability required.  Reasonable accommodations may be made to enable an individual with a disability to perform the essential duties and responsibilities.

EDUCATION AND EXPERIENCE

High School Diploma or General Equivalency Diploma (GED) required.  American Academy of Professional Coders (AAPC) certification required.

Minimum 3-5 years of experience with Hospital or Physician Medical Benefits and/or Billing experience. At least 2 years of medical coding experience that includes knowledge of CPT coding guidelines, medical terminology, anatomy and physiology, state and federal Medicare reimbursement guidelines.

Must be proficient with Microsoft Office.  Must have excellent organizational and planning skills as well as strong communication and decision-making skills.  Must be able to manage multiple tasks and priorities in a fast-paced environment.

Email your cover letter and resume to: jobs@pchcares.org

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