Reimbursement Specialist LPG - Fort Myers, United States - Lee Health
Description
Location: The Sanctuary - Regional Cancer Center
Department: Oncology Outpatient
Workdays/Nights: Days
8931 Colonial Center Drive
Shift: Shift 1
9:00:00 AM to 5:30:00 PM
Fort Myers,FL33905
Work Type: Full Time
Exempt: No
Job Summary
Summary:
Review charges prior to billing to include but are not limited to review and problem-solve charges in order to ensure claims are coded correctly applying modifiers when necessary and appropriate to payer specific guidelines. Insurance specific Epic WQ's are reviewed to capture accurate payer compliance as well as maximum allowable reimbursement is secured in addition to providing an opportunity to possible capture any missed charges. Identify and define appropriate procedure and diagnoses codes for existing and new services. Identify and provide information on proper coding guidelines, insurance regulations, medical records and physician documentation and signature requirements. Advise managers or possible billing problems and initiate plans for solving such problems. Review and release information to persons and agencies according to regulations on medical records request received. Resolve or clarify codes and diagnoses with conflicting, missing, or unclear information by consulting with providers or practices. Participate with regular coding and claim team meetings. Provides claim follow up assistance to the AR team for resolution of payment on unpaid or denied claims for LMHS employed physicians by securing maximum reimbursement through enhanced and accurate coding and billing. Duties include but are not limited to reporting, research, customer service inquiries and resolution, intra and inter departmental commutations, training and leading the staff in efficient and productive billing and coding techniques.
Job Requirements
Responsibilities:
Educational Requirements
Degree/Diploma ObtainedProgram of StudyRequired/Preferredand/orHigh School Diploma or EquivalentRequiredorGEDRequired
Experience Requirements
Minimum Years RequiredArea of ExperienceRequired/Preferredand/or2 YearsBilling/InsuranceRequiredand3 YearsOutpatient CodingRequired
State of Florida Licensure Requirements
LicensesRequired/Preferredand/orNot Required
Certifications/Registration Requirements
Certificates/RegistrationsRequired/Preferredand/or
US:FL:Fort Myers