- Responsible for working pre-bill edits including but not limited to CCI edits and claim scrubber edits. Collaborates with intra-departmental teams to determine root cause.
- Performs denial investigation and corrections to secure claim payment.
- Identifies opportunities for denial prevention through revenue cycle.
- Maintains an understanding of regulatory and payer changes to ensure correct charging and billing requirements are met.
- Maintains working knowledge of coding and billing regulations for all payors. Keeps current on regulatory updates, local payer policies and procedures to ensure charge accuracy, compliance and optimization.
- Contact patients in order to obtain or relay billing account information.
- Field questions from patients, clerical staff, and others.
- Cooperating with the billing manager to ensure that their work adheres to the standards, guidelines, procedures, and deadlines set by the company.
- Maintains a professional relationship and positive attitude with co-workers, patients and all M.I.N.D staff.
- Strives to learn more and receptive to new challenges and opportunities.
- Displays enthusiasm toward the work and the mission of M.I.N.D.
- Must possess and demonstrated knowledge of the following:
- Medical Terminology
- CPT Codes
- HCPCS codes
- ICD 10 Codes
- NCCI Edits
- Appropriate Modifier Usage
- General knowledge of how to interpret a LCD, NCD and payer policies
- Claim adjudication codes (RARC, CARC)
- General knowledge of the explanation of benefits
- Resubmission Codes
- Knowledge of electronic appeal processes
- Preferred knowledge of infusion, imaging, procedural billing.
- 1+ years or recent experience in high volume medical billing (40 providers).
- Extensive knowledge of insurance payers (including Medicare, Medicaid, VA plans, Commercial plans), third-party payer rules and requirements.
- Knowledge of computer operations, including EMR/PM systems and electronic interfaces related to charge documentation, capture and billing is required.
- Proficient in general computer skills and Microsoft products such as Outlook, Teams, Excel.
- Proficient in navigating payer websites and clearinghouses such as Availity, Waystar, etc.
- Exceptional organizational skills and ability to prioritize and manage multiple functions and responsibilities simultaneously.
- Problem solving, critical thinking and time management skills.
- Good written and verbal communication skills.
- Travel – none
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Description
Job Description
Job DescriptionJob Description – Medical Billing AR SpecialistClassification – FSLA - Non-Exempt - hourlySalary Grade/Level/RangeLevel of experience, longevity, within current company pay structure.Reports toRevenue Cycle ManagerSummary/ObjectiveMedical Billing AR Specialists perform analysis of patient clinical and billing data to identify documentation, coding and charging opportunities. Works pre-bill edits and post adjudication denials to secure claim resolution.Essential Functions
This job operates in a medical office facility.Physical DemandsThis position requires the ability to sit for long periods of time, view computer screens for long period of time, answering calls on a multi-line phone system, writing, reading and note taking. Position Type/Expected Hours of Work
This is a full-time position. Days and hours of work are Monday through Friday, varying hours between 8:00 a.m. to 4:30 p.m.
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. Employees should adhere to all approved policies, procedures and philosophies.
