Medical Billing and Coding Specialist
Chiropractic Health Partners MSO LLC, Sarasota, Florida, United States, 34243
Reporting to the Billing Manager, this employee will be a key member of the billing team for this fast-paced, innovative growth company comprised of multiple chiropractic practice brands. The Medical Billing and Coding Specialist will be held accountable for:
Handling billing of payer and personal injury claims which may be Commercial, Managed Care, Medicaid or Medicare
Preparing and submitting patient claims to all health insurance payors and personal injury attorneys
Assisting the billing team with claim submissions, denials and rejections management, patient accounts and various other administrative duties
Ensuring appropriate codes are assigned and medical documentation is complete
RESPONSIBILITIES:
Obtain and follow-up on prior authorizations Review and confirm that appropriate billing documentation has been obtained, including authorizations and Certificates of Medical Necessity as required Post charges and reconcile EOBs for posting payments Work with insurance aging reports, denials/rejections, and re-submission of claims taking into consideration coordination of benefits, medical necessity, prior authorization & referral requirements, modifier usage, payor policies, CPT/HCPCS coding, ICD 10 coding and eligibility Coding:
Assign appropriate medical codes to diagnoses and procedures. Ensure compliance with coding guidelines and regulations Review patient medical records for accuracy and completeness. Work closely with providers to clarify documentation Assist in resolving any coding-related denials or discrepancies Characteristics and Behaviors for Success:
A results-oriented style that focuses collaboration with matrix teams to achieve results Ability to master complex business problems and have the intellect and pragmatism to be able to effectively handle ambiguity and manage change. Ability to adapt and be flexible in a rapid changing work environment is required Strong attention to detail and accuracy in data entry and documentation Qualifications:
5 years of experience with billing and coding in a physician office setting Strong knowledge of CPT, HCPCS, ICD 10 guidelines, Medicare and commercial insurance policies, and claim denial reasons AAPC billing and/or coding certification preferred Experience with personal injury claims a plus Have overall proficiency with revenue cycle workflows Must be willing to travel to CHP’s affiliated practice locations should the need arise
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Obtain and follow-up on prior authorizations Review and confirm that appropriate billing documentation has been obtained, including authorizations and Certificates of Medical Necessity as required Post charges and reconcile EOBs for posting payments Work with insurance aging reports, denials/rejections, and re-submission of claims taking into consideration coordination of benefits, medical necessity, prior authorization & referral requirements, modifier usage, payor policies, CPT/HCPCS coding, ICD 10 coding and eligibility Coding:
Assign appropriate medical codes to diagnoses and procedures. Ensure compliance with coding guidelines and regulations Review patient medical records for accuracy and completeness. Work closely with providers to clarify documentation Assist in resolving any coding-related denials or discrepancies Characteristics and Behaviors for Success:
A results-oriented style that focuses collaboration with matrix teams to achieve results Ability to master complex business problems and have the intellect and pragmatism to be able to effectively handle ambiguity and manage change. Ability to adapt and be flexible in a rapid changing work environment is required Strong attention to detail and accuracy in data entry and documentation Qualifications:
5 years of experience with billing and coding in a physician office setting Strong knowledge of CPT, HCPCS, ICD 10 guidelines, Medicare and commercial insurance policies, and claim denial reasons AAPC billing and/or coding certification preferred Experience with personal injury claims a plus Have overall proficiency with revenue cycle workflows Must be willing to travel to CHP’s affiliated practice locations should the need arise
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