Billing Technician

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Receives and examines alternate resource claims to assure claims are complete with appropriate supporting documents which typically include utilization review certifications. Verifies accuracy of health claims number that claimed amounts are authorized and items of services billed are allowed by appropriate regulations, decisions, directives and other controlling guides.

Provides technical assistance with processing and maintaining coding, abstraction of the complete chart (outpatient) and compliance enforcement of all regulatory requirements. Review, analyze Current Procedural Terminology (CPT) coding, abstract and compile date, maintain and identify potential risk areas in outpatient medical record.

Conducts a thorough review of all abstraction and search of records, guidelines in order to select the most accurate and descriptive codes in accordance with coding systems. Code selection involves discriminating between several different codes, which can overlap in scope, encompass multiple diagnosis, treatments or operations; and include special codes to denote causes of accident/injury or adverse effects required for billing.

Consults with the attending physician, laboratory and all other necessary departments for compliance with all the regulations and guidelines pertinent to False Claims Act and facilities Compliance Program in preparation for itemize billing.