What are the responsibilities and job description for the Billing/Scheduler position at SPCP/Southeast Medical Group?
Job Description
Job Description
Description :
This position is expected to have excellent reasoning skills based on knowledge of clinic operations as it pertains to billing claims to Insurance Health Plans, coding for medical diagnosis and procedural coding. Individual must be familiar with the conventions and instructions provided within the ICD disease classifications and CPT coding guidelines. Should also be able to reason through insurance claims differences as defined by benefit and plan differences. This position is responsible for resolution of A / R in a complete, accurate, and timely manner while verifying that industry rules and regulations, including, local, state, and federal regulations, regarding billing and collection practices are followed; as well as with established internal policy and procedure.
Requirements :
- Review medical record documentation to identify services provided by physicians and mid-level providers as it pertains to claims that are being filed.
- Verifies appropriate CPT, ICD, and HCPCS codes to accurately file claims for the physician service using the medical record as supporting documentation.
- Performs corrections for patient registration information that includes, but is not limited to, patient demographics and insurance information.
- Responsible for working EDI claim rejections in a timely manner.
- Receives and interprets Explanation of Benefits (EOB) that supports payments from Insurance Carriers, Medicare, or patients. Able to apply correctly to claims / fee billed.
- Processes incoming EOBs to ensure timely insurance filing or patient billing. May require correction of data originally submitted for a claim or Coordination of Benefits with secondary insurance.
- Responsible for processing payments, adjustments and denials according to established guidelines.
- Responsible for reviewing insurance payer reimbursements for correct contractual allowable amounts.
- Responsible for reporting payer payment and denial trends in a timely fashion.
- Responsible for reconciling transactions to ensure that payments are balanced.
- Responsible for reducing accounts receivables by accurately and thoroughly working assigned accounts in accordance with established policy and procedures.
- Responsible for keeping current with changes in their respective payer’s policies and procedures.
- Communicates with the Clinics to provide or obtain corrected or additional data.
- Able to prepare documents for training or for establishing procedures for clinics.
- Identifies problems and root cause of problems related to billing and collections.
- Assist with training materials and training staff members.
- Responsible for identifying problems / trends in medical documentation and reporting them in a timely fashion.
- Answers patient and customer questions regarding billing and statements.
- Prepare claims for encounters with complex progress note issues.
- Participates in special assigned projects.
Minimum Required Education, Experience & Skills
Preferred Education, Experience & Skills
Physical & Mental Requirements :
