Prepare, review, and submit claims to insurance companies accurately and within specified timelines, ensuring that all claims meet payer requirements.
Ensure that claims are complete, with all necessary documentation and coding included to prevent rejections or denials.
Monitor claims for accuracy, resolving discrepancies, and conducting follow-ups on outstanding claims to facilitate timely payment.
Coding and Documentation Compliance
Apply accurate ICD-10, CPT, and HCPCS coding in compliance with payer and regulatory guidelines, ensuring that services are appropriately coded for optimal reimbursement.
Work with clinical and administrative teams to clarify and obtain necessary documentation or coding details, ensuring claims are coded accurately.
Keep up-to-date with current coding practices, payer guidelines, and regulatory requirements to maintain compliance and accuracy in claim submissions.
Claims Submission and Follow-Up
Verify patient insurance coverage and eligibility prior to claim submission, ensuring that payer requirements are met to avoid rejections.
Submit claims electronically or via paper as required by payers, confirming that claims are processed efficiently within the revenue cycle.
Conduct follow-up on submitted claims, contacting payers when necessary to resolve any issues or delays, and taking corrective action on denied or rejected claims.
Billing and RCM Compliance
Maintain strict adherence to HIPAA and all applicable billing and coding regulations to ensure patient privacy and compliance.
Assist with periodic audits of billing and coding practices to ensure compliance with payer and regulatory guidelines.
Stay informed about industry updates, payer requirements, and changes in billing codes to ensure that claim submissions reflect current standards.
Qualifications:
Education: High school diploma or GED required; an Associate’s degree or certification in medical billing, coding, or a related field is preferred.
Experience:
1-3 years of experience in medical billing, coding, or claims processing.
Knowledge of ICD-10, CPT, and HCPCS coding, as well as familiarity with EHR/EMR and billing software.
Certifications: CPC (Certified Professional Coder), CBCS (Certified Billing and Coding Specialist), or similar certification preferred but not required.
Skills:
Strong understanding of medical terminology, billing procedures, and coding practices.
Excellent attention to detail with the ability to accurately file claims and identify discrepancies.
Strong communication skills, with the ability to work effectively with team members, clients, and external payers.
Proficiency with Microsoft Office (Word, Excel) and billing software systems.
Competencies:
Attention to Detail: High level of accuracy and thoroughness in reviewing, coding, and submitting claims, ensuring adherence to payer guidelines.
Problem Solving: Ability to identify and resolve billing discrepancies or coding issues, working proactively to prevent claim rejections.
Compliance-Oriented: Committed to maintaining strict confidentiality and compliance with HIPAA, payer guidelines, and regulatory requirements.
Organizational Skills: Effective time management and organizational skills to handle multiple claims, follow-ups, and ensure timely submission.
Communication: Skilled in clear and professional communication with internal teams, clients, and payers to resolve issues and clarify documentation.
