Coding/Billing Specialist

Pinehurst Medical•West End, NC

3d•Onsite

About The Position

The Coding/Billing Specialist is responsible for the reviewing and processing of inpatient/outpatient hospital and office charges for physicians and APPs, along with billing charges through our Practice Management system, while checking for correctness and completeness prior to the charge document being processed for billing, insurance filing, and revenue reporting.

Requirements

High school diploma or general education degree (GED); or one year related experience and/or training; or equivalent combination of education and experience.
Previous experience with outpatient billing to include CPT, ICD-10 coding.
Detail oriented with strong financial emphasis.
Medical Office experience.

Responsibilities

Verifies and/or enters hospital registration and/or financial data efficiently and accurately through a computerized billing system.
Responsible for maintaining up-to-date knowledge of coding and diagnostic procedures, as well as remaining current regarding federal legislative changes that affect outcome when provided with appropriate literature.
Receives physician/APP charges from multiple locations.
Reviews all charges for accuracy, asks questions when necessary, and understands the appropriate use of CPT and/or ICD-10 codes. Contacts appropriate personnel for clarification, etc.
Assigns/reviews the CPT codes, diagnosis codes, and assign modifiers when applicable to charges.
Responsible for reconciling all missing tickets for assigned services.
Reconciles Daily/Monthly Logs that are generated by local hospitals.
Responsible for working claim scrub queues with a multitude of accounts and charges to correct bundling guidelines and NCD/LCD coverage policies, as well as working denials from Insurance companies.
Responsible for filing appeals on denied claims or providing additional information to third party payers to facilitate reimbursement.
Responsible for obtaining prior authorization for scheduled procedures.
Responsible for telephone and written inquiries regarding precertification and insurance related matters.
Assists with denial resolutions, with direct participation with management and other staff members.
Responsible for working missing referral reports.
Prepares telephone, written, or on-line pre-certification requests providing detailed explanation.
Verifying patient benefits calling patients with estimated OP cost for Infusion Drugs. Position is also responsible for enrolling some patients into Copay Plans.
Other duties as assigned.