Medical Biller/Coder
Company: Su Clinica
Location: Harlingen
Posted on: June 24, 2022
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Job Description:
This position is vital in the health care delivery system in
function with the fiscal aspect of the Clinic. Adhere to policies
and procedures in conducting all clinical charges, payments,
adjustments for proper billing and collections. Bills and submits
claims to insurances/programs, follows up on claims statuses,
resolves claim denials, submits appeals, post payments and
adjustments, and manages collections. Great customer service and
telephone etiquette, computer knowledge, professional appearance,
attention to detail, able to multitask and work in a fast paced
environment. Ability to work well under stress and maintain calm
under pressure and work well with team members and willingness to
cross-train. - Functions as a member of a collaborative health care
team to create and maintain a patient centered medical
home.Communication: Communicates with outside providers offices and
insurance/program representatives by telephone in a pleasant,
culturally and linguistic manner or by secure email. - -Assure all
questions are answered or resolved in a positive and cordial manner
regarding billing issues and/or collection of fees for timely
billing. -Communicates unresolved issues to the supervisor or
designee as needed. -Primary Billing Functions: Reviews and
analysis patient's medical records for accuracy in correct
diagnosis and CPTs, HCPCs codes for billing. Bills and codes as per
policies and procedures of each specific program/grant and/or
insurance. Accurately enters daily office and/or hospital charges
into our database using medical coding protocol to produce a
statement or a claim for payment. Reviews medical records and
efficiently addresses any discrepancies in coding with the medical
provider. Verifies insurances when needed. Performs root cause
analysis and identifies trends timely to minimize lag delays and
maximize opportunities to improve processes. Enters payments
received on accounts, applies payment to existing charges and
ensures account balances are current and correct to include third
party payers. Productivity measures must be maintained at all times
to ensure insurance, program/grants deadlines are not missed and
all revenue is capturedTraveling to different clinics when needed
to train or gather information for proper billing. -Secondary
Collections Functions: Submits claims daily to carriers via
electronic batches, reconciles batches per system protocols.
Responsible for accurate and timely resolution of preparing
professional billing claims and working clearing house edits;
obtaining referral information and authorizations for encounters as
required by payers. -Responsible for working daily on rejections
and denials and ensuring billing deadlines are not missed.
-Identifies and documents new payer denial trends and notifies
supervisor. -Follows up and thoroughly researches reason for
denied/rejected claims and works appeals as necessary to resolve
outstanding balances. Ensures appeal deadline with payers are not
missed. -Downloads electronic and reviews EOB's and correct errors
promptly. Posts insurance payments accurately against patients
accounts and reconcile charges on a daily basis. Works all
correspondence received, including zero payments, denials and other
information received from insurance carriers on a daily basis.
Assists in providing copies of medical records including billing
records in a HIPAA compliant manner. Receives calls from outsides
offices and assists questions regarding payments, EOB's and reasons
for denials as requested by the patient at the office. Other duties
as assigned -Team Communication: works closely with physicians, and
other departments to resolve issues with insurance companies
regarding incorrect registration information, claims processing,
coding issues and AR payments or denials. Educates staff on
insurance policies to minimize denials/rejections as needed. -
-Management of Documentation: Assures all billing and collection
documentation is accurate and current. - Documents all adjustments
and or refunds as needed. - Assures all appropriate documentation
required for our clinic programs is accurately captured. - -
Documents all adjustments and or refunds as needed. -Demonstrates
Safe Professional Conduct: Submits required documentation in a
timely manner (credentialing requirements, license renewals,
certifications, CNE attendance, etc.). Responsible for their own
safety as well as the safety of others. Must always adhere to a
professional appearance in dress and behavior/conduct. Maintains a
friendly environment for self and others. Refrains from texting and
speaking on the cell phone. - Refrains from informal communication
with patients and others. Fully participates in performance
improvement and follows all Clinic policies and procedures. Attends
work on a regular and predictable schedule in accordance with
clinic leave policy and performs other duties assigned. Submits
required documentation in a timely manner. -High school diploma or
GED; plus graduation from an accredited vocational program in
Billing and Coding or two years' experience as a medical
biller/coder.
Keywords: Su Clinica, Harlingen , Medical Biller/Coder, Healthcare , Harlingen, Texas
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