Pediatric Practice is searching for an experienced network revenue specialist, pediatric coding experience preferred.
Education/Certification:
- High School Diploma required
- Associate degree preferred
- Completion of Coding and Billing program preferred
- Coding/Billing Certification preferred (CPC, CPC-A, CCA, CCS, CCS-P, RHIT, RHIA)
Experience:
- Minimum two years of coding/billing experience in a medical insurance office environment, Health information management, a hospital billing or physician billing setting required
- Pediatric office experience preferred
- EClinicalWorks EMR software experience preferred
Essential Functions:
- Reviews and verifies assigned codes and sequences diagnosis and procedures according to regulations (e.g., ICD10CM, CPT, and HCPCS coding guidelines) and abstracts accurate clinical information to obtain the most specific code possible to ensure an accurate health information database.
- Detailed knowledge of the CMS guidelines for the assignment of E&M, diagnosis, and procedure codes
- Contacts physicians and other medical staff for clarification of clinical information as appropriate for account type as necessary
- Maintains up-to-date knowledge of coding and regulatory requirements to accurately assign codes for appropriate reimbursement of healthcare services.
- Utilize web-based tools, coding books, and other available resources to facilitate providing insurance companies with the required information.
- Responds to inquiries from providers and various internal departments in a timely and accurate professional manner.
- Assigns charges for self-pay patients, bills patients for balances, collect payments from patients via phone
- Reviews and updates patients insurance and demographic information
- Identifies past-due bills and sends for statement processing
- Answers questions via phone and web contact form regarding payments and reimbursements
- Interacts with private and government payers to facilitate the prompt payment of accounts receivable.
Skills/Abilities:
- Must be knowledgeable of medical anatomy, medical and insurance terminology
- Must be knowledgeable of the CMS guidelines for the assignment of E&M, diagnosis, and procedure codes
- Great customer service skills
- Ability to interpret EOB and ERA documentation
- Ability to multi-task
- Great attention to detail
- Ability to work independently to effectively and efficiently perform assigned duties
- Flexible, team player
