Procedural Billing Specialist I

Position : Procedural Billing Specialist I

Local Pay Rate : $20 / hr

Location : New York, NY

Hours Per Week : 37.50

Hours Per Day : 7.50

Days Per Week : 5.00

Schedule Notes : 9am-5pm M-F

Urology coding experience

Job Summary :

• Performs specialized coding services for inpatient and outpatient medical office visits. Reviews physician coding and provides updates.
• Provides comprehensive financial counseling to patients. Responsible for setting patient expectations, discussion of financial options, payment plans, one-time settlements and resolution of unpaid balances.
• Discusses with patients the details concerning their insurance coverage and financial implications of out-of-network benefits, including pre-determination of benefits, appeals and / or pre-certification limitations.
• Develop and manages fee schedules and for self-pay patients.
• Processes Worker’s Compensation claims and addresses / resolves all discrepancies.
• Conducts specialized negotiations with insurance companies. Brokers and negotiates with insurance carriers. Establishes a network of key representatives within the insurance pre-certification units to establish open lines of communication for future service negotiation.
• Verifies insurance and registration data for scheduled office, outpatient, and inpatient procedures. Reviews encounter forms for accuracy.

Responsible for obtaining pre-certifications for scheduled admissions.

• Enters office, inpatient, and / or outpatient charges with accurate data entry of codes.
• Posts all payments in IDX. Runs and works missing charges, edits, denials list and processes appeals. Posts denials in IDX on a timely basis.
• Provides comprehensive denial management to facilitate cash flow. Tracks, quantifies and reports on denied claims.
• Directs and assists with responses to problems or questions regarding benefit eligibility and reimbursement procedures.
• Researches unidentified or misdirected payments.
• Works credit balance report to ensure adherence to government regulations / guidelines.
• Analyzes claims system reports to ensure underpayments are correctly identified and collected from key carriers. Reviews and resolves billing issues and provides recommendations.
• Identifies and resolves credentialing issues for department physicians.
• Maintains a thorough understanding of medical terminology through participation in continuing education programs to effectively apply ICD-10-CM / PCS, CPT and HCPCS coding guidelines to inpatient and outpatient diagnoses and procedures.
• Meets with practice management, leadership and / or physicians on a scheduled basis to review Accounts Receivable and current billing concerns.
• Mentors less experienced billing staff and assists Billing Manager / Revenue Cycle Manager in staff training.
• Other identified duties as assigned.

Skills :

Required Skills & Experience :

• Excellent organizational skills.
• Excellent communication and customer service skills.
• Knowledge of medical terminology and anatomy.
• Strong attention to detail and ability to multitask.
• Excellent calculation, verbal and communication skills.
• Strong ability in analysis and research.

Preferred Skills & Experience :