Claims Processor

Miami, FL

Posted: 05/17/2019 Employment Type: Temporary/ Hourly Industry: Claims Processing Job Number: 73236 Pay Rate: $18/HR

Seeking a Claims Processor who will be providing billing and/or claims management support to a great physician's practice team in the Miami, FL area. This role will comply with payer filing deadlines by utilizing all available resources to resolve held claims.  

 

Additional responsibilities include:

  • Utilizes hospital-based applications/databases to verify/review patient registration or work all general levels (non-surgical) of assigned tasks to ensure accuracy, support claims processing and meet productivity standards.  Provides all updates to applicable applications. 
  • Processes edits identified through EPM and validates information in related coding manuals. 
  • Follows and ensures adherence to official coding guidelines and reimbursement requirements.
  • Follows up with appropriate parties for claim data resolution and notates the system with updates throughout each step in the process.
  • Reviews claims data and supporting documentation submitted for billing to ensure appropriate coding and billing (i.e. diagnosis and CPT codes). 
  • Updates coding as needed to comply with guidelines, providing appropriate communication and education to providers and medical group staff.
  • Queries physicians through the department’s processes when code assignments are not defined, documentation in the record is inadequate/unclear or does not meet documentation guidelines. 
  • Clearly documents work in applications as directed. 
  • For claims management, responsible for all appeal verbiage and instructions when claims are appealed.
  • Responsible to ensure all claims in queue, placed on hold, or pending in assigned work logs are completed timely and accurately. 
  • Escalates unresolved issues through appropriate leadership chain.
  • Ensures edits are completed daily.
  • Considers our payer contracts when working tasks, addressing payment matters, and incorporating billing guidelines. 
  • Stays abreast of provider credentialing and payer-related contractual matters. 
  • Remains current with changes in the health care industry by participating in continuing education courses. 
  • Stays abreast of CPT-4, HCPCS, ICD-9, ICD-10 and Revenue Code updates as they pertain to the appropriateness on the bill.
  • Meets all customer service initiatives.
  • Ensures refunds, patient inquiries, and practice inquiries are addressed.
  • Abides by all HIPPA regulations. 
  • Is confidential and accesses all patient information only as needed for business and as appropriate by policy guidelines.

 

Interested? Apply directly now or give us a call at (Dade: 305-595-3800 / Broward: 954-437-0070) Questions about this role or others? Email mariam@cxcinc.com for more information. 

  

*CAREERXCHANGE® is an equal opportunity employer. We will present the most qualified candidates to our clients based on the skills required to perform the job. For additional opportunities please visit www.careerxchange.com.

  • Minimum two years of charge entry or claims management experience.  Years of experience may suffice for initial certification requirement. 
  • Must possess working knowledge of coding and charge entry or claims management processes. 
  • Knowledgeable in physician billing, regulatory, and compliance guidelines, as well as appeal processes.  Possesses effective verbal and written communication skills. 
  • Experienced with Microsoft Word and Excel and work well with new applications. 
  • Experience with NextGen (Preferred), as well as hospital-based software.

  

Licensure, Certification, and/or Registration:

  • AHIMA Certified Coding Associate (Preferred)
  • AHIMA Certified Coding Specialist (Preferred)
  • AHIMA Certified Coding Specialist-Physician-based (Preferred)

Maria Martinez
Executive Recruiter

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