Reporting to the Billing and Collections Manager, this position is responsible for Code Review, Insurance Billing and Insurance Collection functions for Staywell Health Care, Inc.
PRINCIPAL DUTIES AND RESPONSIBILITIES
- Review patient’s medical, dental or behavioral health charts to ensure assigning of the appropriate diagnostic and procedural codes within EHR system and return encounter notes to physicians as deemed necessary to ensure accuracy and integrity of charges captured.
- Post Daily Pending Charges and any hospital charges ensuring all are processed.
- Verify receipt & acceptance of claims by claims processing center, NWS and Claim Tracker.
- Research and resolve all accounts receivable reports and claim denials, processing of appeals where appropriate, and providing recommendations for write-off’s or adjustments.
- Post payments daily and accurately either via ERA or manually, disallows and/or denials to appropriate patient account; calculate patient responsibility; interpret explanation of benefit message codes; identify payment discrepancies (i.e., rejections) by contacting insurance carrier, and determine if rebilling is necessary. Prepare and submit paper claim on rare occasions as needed.
- Respond to inquiries from agencies, bureaus and insurance companies to assist in the claim payment processing.
- Process patient, clinic and insurance correspondences, including requests for refunds and collections when warranted timely.
- Record adjustments to proper accounts and determine the appropriate destination for unidentified funds.
- Function as liaison between patients and clinic staff on coding, claims, denials, and insurance related questions and issues.
- Act as a resource to physicians, administrators and patients regarding coding compliance, health insurance claim policies, procedures and requirements.
- Provide support to the Billing and Collections Manager on various areas of coding and patient billing compliance, research and analysis, daily and/or month-end processes.
- Perform special projects as assigned by the Billing and Collections Manager or CFO.
- Accountable for timely and accurate completion of job assignments.
The work is primarily sedentary with some walking, standing, bending, carrying of light items, such as manuals and books. The position requires the ability to lift/carry 10 pounds maximum, 1-5 pounds frequently. Hearing and vision compensated to a functional level that is required to meet the essential functions of the job. The position requires manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment.
The Insurance Specialist works in an office setting that is adequately heated, lighted and ventilated. The work environment involves the normal risks and discomforts typical of a community health center.
JOB SPECIFICATION AND QUALIFICATIONS:
- Strong communication and interpersonal skills; ability to communicate effectively and project a positive image.
- Ability to maintain confidentiality.
- High School Diploma/GED required
- Certified Professional Coder (CPC) or Certified Coding Specialist designation (CCS) required.
- Knowledge of: medical, dental and behavioral health coding (CPT, ADA and ICD-9); coding compliance and billing procedures with Medicare, Medicaid, HMO and third party insurance; medical and dental terminology, documentation requirements; Practice Management System (Intergy); federal and state regulatory requirements.
- Ability to provide guidance to professional and clinical staff.
- Knowledge of current and developing compliance issues and trends in healthcare coding procedures requirements and how it applies to Community Health Centers.
- Ability to analyze and solve problems.
- Work independently with minimum supervision.
How to Apply
StayWell Health Center