Certified Coding Specialist

General Description :

This position is responsible for collecting payments from third-party medical, dental, and behavioral health payors. Collections activities include denial research, preparing & submitting appeals, and following up on unpaid, partial paid, or incorrectly paid claims. This includes identifying consistent payer-related payment delays, systematic denials, and communicating patterns to management. Collections Specialists will also support registration and insurance changes.

Responsibilities

Job Responsibilities

Specific Responsibilities of the Job :

• Monitor claims status for prompt and accurate payment.  Follow up on, correct, and / or re-submit rejected, denied, partially paid, and incorrectly paid medical, dental, and behavioral health claims to insurance carriers in a timely manner.  Ensure proper documentation is attached to corrected claims, if needed.
• Respond to payor correspondence; secure and submit additional documentation required or requested by insurance carriers.
• Identify coding, billing, and / or payment errors from EOB / ERA and make indicated corrections.
• Identify consistent payer delays, systematic denials, and other patterns and communicate them to management.
• Demonstrate and apply thorough understanding of insurance plan, Medicare, and Medicaid contracted rates, terms, and regulations to identify inaccurate payments and / or adjustments.
• Investigate, analyze, and resolve denials from insurance carriers.
• Understand and Analyze EOB / ERA information, including co-pay, deductible, co-insurance, coordination of benefits, contractual adjustments, denials, etc. to verify accuracy of insurance payments and patient balances
• Post charges, payments, adjustments, etc., as assigned.
• Maintain current knowledge on insurance carrier billing requirements and changes
• Accurately and timely update insurance, payment, and claim activity information in EHR / billing system.  Demonstrate thorough understanding and effective, accurate use of the EHR / billing system.
• Collaborate effectively with patients, providers, and staff as needed to obtain needed information and to continually improve organizational billing and collections performance.
• Other duties as assigned.

Required Skills

Required Knowledge, Skills and Abilities :

Education and Experience :

Preferred Qualifications :