Billing & Coding Specialist

Job Description

Job Description

39 Paid Days Off Each Year

Position Summary

This position focuses on all elements of revenue cycle processes from claim creation to follow-up on denials including handling and adjusting patients’ accounts per EOB response. Additionally, the position requires taking care of any patient queries in regard to statements, fulfilling itemized bills for law firms and processing patients and insurance refunds.

Duties and Responsibilities

1. Process missing slips in Athena and create claims according to payer’s requirements and guidelines.
2. Follow up on all denied claims and drive it to proper resolution.
3. Process inpatient charges in Alert MD.
4. Process chronic care coordination charges in Time Doc.
5. Identify claims that need referrals or additional information for payment.
6. Manually post dental payments in Dentrix.
7. Process, follow up on and resolve requests for itemized bills.
8. Manage and follow up on payment plans offered to patients with outstanding balances.
9. Review and analyze account balances to determine true insurance and patients’ refunds.
10. Follow up with patients when updated insurance information is needed to process claims.
11. Maintain regular communications with patients until such time that accounts are paid in full.
12. Attend all departments’ meetings as well as PrimeCare all-staff meetings.
13. Coordinate and submit settlement offer for approval.
14. Other duties as assigned.

Required Skills or Abilities

1. Work effectively with a diverse group of professionals within the whole organization.
2. Exercise independent judgment and prioritize effectively.
3. Analyze, recommend, and implement creative improvements.
4. Demonstrate ability to work independently and in a team-based environment.
5. Strong interpersonal skills demonstrating ability to establish strong working relationships and communicate effectively in a confidential manner.
6. Maintain appropriate professional boundaries with all staff, trainees, and patients at all times.
7. Demonstrate respect and sensitivity for cultural diversity, gender differences, and sexual orientation of patients and co-workers.
8. Strong knowledge of ICD-10, CPT-4 and HCPCS coding as well as basic medical terminology
9. Ability to interpret and analyze EOBs (explanation of benefits).
10. Proficient skills/experience with Microsoft Office products (Outlook, Word, Excel, PowerPoint) and Adobe.

Required Knowledge, Experience, or Licensure/Registration

1. Bachelor’s degree in business administration, accounting, or finance preferred.
2. CPC or CPC-A certifications strongly preferred.
3. 3 – 5 years of experience in outpatient/inpatient Medicaid, Medicaid MCOs, Medicare, Medicare Replacement, and commercial insurance billing preferred.
4. Prior experience in health care organizations and experience in FQHC strongly preferred.
5. Prior experience with Athena EMR strongly preferred.

Benefits

• 27 days of PTO each year, accrued each pay period
• 3 personal days
• 1 floating holiday
• 8 paid holidays
• Medical/Dental/Vision coverage available the 1st of the month following 30 days
• Company-paid life, short-term disability, and long-term disability coverage
• Discretionary 403(b) match and profit sharing after meeting service requirements
• Flexible spending accounts
• Accident & critical illness coverage
• Pet insurance

Salary

All wages are based on relevant years of experience. The minimum rate is the wage a candidate with no additional experience will earn.

PrimeCare Health is firmly committed to creating a diverse workplace and is proud to provide equal employment opportunities to all applicants . T herefore, PrimeCare does not discriminate on the basis of creed, color, national origin, sex, gender identity, sexual orientation, age, religion, marital or parental status, alienage, disability, political affiliation or belief, military or military discharge status.