Description

Job Summary: Applies in-depth knowledge of industry standard billing and coding rules to correct errors and resolve problems related to preparing and submitting accurate medical bills for services provided in ASC settings. Follows up on denials for coding and non-coding reasons, and files appeals as appropriate. Posts cash, negotiates payment arrangements, identifies accounts for collection, and answers billing questions from customers. This Position will report to the Business Office Manager. 

Essential Duties and Responsibilities:

• Focusing on billing issues, applies in depth knowledge of industry standard billing and coding rules to correct errors and resolve problems related to preparing and submitting accurate bills for services provided in ASC settings. Involves errors that have to do with ICD-10-CM, CPT and HCPCS codes on the bills. May involve abstraction from the medical record.
• Identifies and communicates denial and error trends. Maintain a log of the types of errors, identify trends over time and participate in root cause analysis for preventative measures. Participates in ongoing process improvement work.
• Applies in-depth knowledge of industry standard billing and coding rules to investigate and resolve issues related to outstanding insurance and patient accounts. Conducts follow-up on claim denials, including denials for coding reasons, and files appeals as appropriate. Via phone, mail, and other correspondence methods, responds to internal and external customer billing issues.
• Receives, posts and applies payments as appropriate. Negotiates payment arrangements and accepts credit card payments. Reviews and supports accounts being sent to collections. Analyzes unapplied cash and re-applies or refunds as appropriate according to written policies.
• Responsible for reviewing invoices daily, prior to inputting information into the Quick Books computerized accounts payable program.
• Provides a weekly, up-to-date computerized accounts payable report to the Business Office Manager with outstanding AR and unbilled claims information.
• Assigns invoices to the appropriate general ledger account number. Obtains clarification when necessary.
• Uploads KP Invoices to One Link for reimbursement of shipping, medications, and items used for procedures that are not reimbursed through the regular claim submission process. 
• Assist Accounts Payable Department as needed. 

Requirements

Knowledge, Skills, and Abilities:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Intermediate PC skills including MS Word and Excel.
• Customer service skills.
• Solid math skills.
• Demonstrated knowledge of industry standard medical billing or coding rules and automated billing systems.
• In-depth knowledge of either ICD-9, CPT/EM, and HCPCS coding and application of coding guidelines for the ambulatory surgical centers and hospital settings.

Basic Qualifications:

• Minimum two (2) years of medical billing/claims processing with ICD-9, CPT and HCPCS experience OR coding experience in any of the following settings: hospital, freestanding ambulatory surgery center or outpatient clinic.
• Vocational school or certificate program in medical billing, health information technology or other similar health care field AND coursework in medical terminology, ICD-9, CPT and HCPCS coding guidelines.
• Professional Coder Certificate preferred at hire OR Registered Health Information Administrator Certificate preferred at hire OR Coding Specialist Certificate preferred at hire OR Registered Health Information Technician Certificate preferred at hire OR Coding Specialist Certificate - Physician Based preferred at hire OR Professional Coder Certificate - Apprentice preferred at hire OR Professional Coder Certificate - Hospital preferred at hire OR Coding Associate Certificate preferred at hire.

Preferred Qualifications:

• Two (2) Years of billing experience.
• Experience with Epic or other electronic medical records.
• College level or technical school coursework in any of the following: medical terminology, medical science, medical billing, disease processes, anatomy and physiology, ICD-10, CPT and HCPCS coding guidelines.