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 email@example.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)