Billing Specialist - Neurology

We are, a freestanding, physician-owned, comprehensive cancer center based in Albuquerque, NM with a satellite clinic in Gallup, New Mexico. We are an Oncology Medical Home, with a focus on early intervention for patient symptoms, resulting in low hospitalization rates. Our Physicians have won Top 10 Docs in the city of Albuquerque multiple times.

As a successful Medical oncology and Radiation oncology practice, we have expanded our medical practice to include Survivorship, Palliative Care, Primary Care, Rheumatology, Pulmonary, Urology, Surgical ENT, General Surgery and Neurology.

Make a difference in the lives of patients by joining a physician-led, partnership organization with a patient-centered and evidenced-based medicine approach. You will have the tools, resources, and professional freedom you need to deliver outstanding patient care.

POSITION SUMMARY:

Billing specialist is responsible for ensuring all Neurology procedures, medications and testing are reviewed for Medical Necessity requirements and prior authorizations are complete. This position will also ensure and perform duties that help the organization achieve its mission, vision while demonstrating and adhering to the core values.

ESSENTIAL FUNCTIONS:

Reasonable Accommodations Statement:

To perform this job successfully, an individual must be able to perform the essential duties satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

Essential Functions Statement(s):

• Review the schedule/inbox and determine which authorizations need worked.
• Calls the payer to determine if the procedure/test requires a PA.
• Ensure that the procedure/test meets all medical necessity requirements based on the LCD, NCD or payer policy.
• Completes all estimates for patient out of pocket for any injections/procedures.
• Calls/faxes/uploads the needed information to the payer and follows up on a response. All contacts are documented.
• Documents the information in the practice management system and/or EMR as needed.
• Attempt to overturn denials if denied and work with the physician to appeal if necessary.
• Checks prior authorizations for all add-on patients in a timely/urgent manner.
• Ensures all office visits and procedures for the day are billed in a timely manner. Documents all notes/visits needing completion by the physician.
• Answers all patient questions as necessary regarding their statement and/or billing inquires.
• Ensure understanding of all policies and procedures.
• Directly interacts with all providers to update on prior authorization status and resolve any issues.
• Provide recommendations to increase efficiency, accuracy, and productivity in the department.
• Informs manager(s)/lead if trends on prior authorizations process change.
• Obtains updates on a regular basis for CPT/HCPCS/ICD-10 and coding from Medicare and other related websites.

SKILLS & ABILITIES:

Education and Experience:

• High School Graduate or General Education Degree (GED).
• 1- 2 years related experience with prior authorizations and billing requirements.
• Work independently as the billing contact within the office.
• Knowledge of CPT/HCPCS/ICD-10 codes.
• Experience and knowledge of healthcare insurance prior authorization/coding.
• Ability to read, interpret and understand documents such as operating and maintenance instructions, and policy and procedure manuals.
• Ability to add, subtract, multiply and divide in all units of measure, using whole numbers.
• Conceptual skills to identify the processes that affect others and know when something changes that will cause a problem.
• Communication with the physicians and clinical staff

Computer Skills:

Basic computer skills, Electronic Medical Records (EMR) & Billing Software.

Compensation/Benefits

Competitive Pay D.O.E.

Generous Benefits Package

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Work Location: In person