Patient Accounts Representative and Certified Coder - Part Time

Saint Luke's Health System•Kansas City, MO

About The Position

The Patient Account Representative Coder will be responsible for reviewing and coding from the medical record, already billed, or suggested from provider or computer generated applications for straight-forward to complex coding, and any account receivable activities for the physician clinics within Saint Luke's Health System. Activities include, but are not limited to, coding, charging, troubleshooting charge related issues, responding to inbound and outbound billing calls from patients, resolving payment credits, identifying and correcting medical claim errors that may prevent payment and identifying, correcting, and resubmitting medical claims denied by insurance companies. Resolving claim edits, working denials and appeals. Evaluation and coding of ICD, CPT, HCPCS. All coding initiatives, NCCI edits, incidentals/inclusive, and bundling rules, etc. Demonstrate competency for invalid diagnosis, modifiers, coding related issues, and be able to have moderate decision making in following coding concepts. This job is 24 hours a week, Monday-Friday, flex hours 6am-9am then work scheduled shift. CPC or CCS required. Percentage of time spent on job duties above will vary dependent on the focus area of team assigned. Charging • Responsible for the first review of designated professional billing charges for accuracy • Review and assign charging codes for accuracy • Responsible for processing CPT and ICD10 billing transaction • Enter and verify the appropriate demographic information, insurance, charges and comments into the computerized billing system • Maintain log of charge postings • Coordinate with billing, coding and revenue integrity teams to resolve billing inconsistencies • Responds to inquiries from provider offices and various internal departments in a timely and accurate, professional manner • Work assigned work queues within in a timely manner • Monitor and respond to questions and requests sent to team shared email account and work with other teams as needed to resolve issues Payments • Responsible for EDI transmissions, electronic and manual payment posting • Resolve electronic remittance errors • Responsible for recording daily bank deposits on entity batch logs • Balance payment batches posted in Epic to cash deposits and resolve variance • Resolve payment posting errors • Responsible for credit resolution of unidentified payments by contacting payors and refunding, when appropriate • Research missing checks, payments, and/or EOBs by contacting payors • Responsible for contacting payors attempting to pay by virtual credit card Credits • Responsible for reviewing patient/guarantor accounts and investigate credit balances (includes reviewing overpayments from insurance companies and patients) • Investigate Undistributed payments in Epic system to determine if should be re-distributed or refunded • Identify trends causing credits and escalate to other team members for resolution • Work assigned work queues within Epic timely Customer Service • Responsible for answering inbound patient calls • Answer patient emails in Electronic Medical Record system. • Making outbound collection calls to patients to obtain information needed to collect payment. • Straightforward coding (i.e. Review patient charts for billing implications or referrals) • Provide price estimates for patients. • Process credit card payments while complying with the Credit Card Handling policy. • Establish payment plans with patients. • Identify patients needing financial assistance. Obtain financial information and review to determine if documentation is needed. Proper, confidential handling of supporting financial documentation. • Research and troubleshoot patient account payment issues. • Serve as liaison between patient and other departments as needed. • Process incoming mail and faxes. • Meet department productivity and quality metric. • Process accounts within a work queue in the Electronic Medical Record system and take action as appropriate • This position is responsible for identifying opportunities and reporting trends to improve patient satisfaction and workflow efficiencies by identifying reasons for patient calls that could have been prevented by education up stream in the process or practice management programming solutions. Examples of this would be educating patients on financial policies, financial expectations of services rendered, correct coding, explanation of coverage, collecting payments when scheduling, system enhancements to identify the correct insurance at registration, correct payment posting, medical necessity warnings.gs. Claim Edits • Responsible for researching patient billing claims to identify and correct coding/claim errors • Responsible for researching patient insurance coverage to identify and resubmit claims to fix coverage denials. • Research and outline documentation needed for respective payor organizations so that claims are processed correctly • Familiarity with NCCI edits, incidentals/inclusive, and bundling rules, etc. • Identify problem trends • Communicate with payors for resolution to complications with claims • Responsible for 277 EDI transactions/rejections • Working with EDI transactions • Payment posting corrections/adjustments and ability to distribute payments • Correct/enter charges • Work with multiple teams/departments to resolve issues • Payment plan or financial assistance coordination Insurance Denials and Follow-Up • Responsible for researching, identifying errors, and correcting claims denied by insurance companies. • Must be able to asses claim to determine when appropriate to make charge adjustments, void a charge, or escalate to the team lead and/or another medical billing team. • Responsible for writing appeal letters to insurance companies • Responsible for following up with insurance companies for no response claims. • Responsible for working with patient calls escalated from the Customer Service team regarding involving billing code issues. • Research refund request from payor organizations • Responsible for preliminary audit of billing code errors before claim submitted to the Coding team. • Responsible for routing complex claim denial to team lead and/or the appropriate medical billing team. • Responsible for identifying issues which can be resolved by programing software to prevent denials. • Responsible for becoming a subject matter expert on the payor policies. • Responsible for communicating and resolving problems with the provider representatives • Responsible for simple level coding, including diagnosis review, modifier applications, some CPT cod changes following process documents and payor policies

Requirements

Applicable Experience: 1 year
CPC or CCS required

Responsibilities

Reviewing and coding from the medical record
Account receivable activities for the physician clinics
Coding, charging, troubleshooting charge related issues
Responding to inbound and outbound billing calls from patients
Resolving payment credits
Identifying and correcting medical claim errors that may prevent payment
Identifying, correcting, and resubmitting medical claims denied by insurance companies
Resolving claim edits, working denials and appeals
Evaluation and coding of ICD, CPT, HCPCS
Charging
Payments
Credits
Customer Service
Claim Edits
Insurance Denials and Follow-Up