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Medical Coder/Biller

Job Description & Responsibilities:

Charges:

Review codes for accuracy (particularly surgery billing) and append appropriate modifiers.
Post charges with correct codes and modifiers.
Balance posting batches before retiring and review for accuracy.
Enter patient demographics when necessary and make corrections as needed. Review demographics prior to submitting any charge on patients' accounts.
Run and review missing ticket reports weekly and notify Manager of delinquent tickets.

Receipts:

Identify, balance and accurately enter physical payments and electronic remittance advise summaries.
Prepare deposits for remote deposit and physical deposit.

Insurance:

File Electronic Insurance Claims
File Paper claims, with appropriate attachments (secondary, med records for Work Comp, etc.)
Follow up on electronic denials, making corrections for resubmission daily.
Research returned paper claims to determine correct claim address and resubmit.

Accounts Receivable:

EOB DENIALS and NO INSURANCE RESPONSE REPORT to be reviewed and addressed initially within 30 days with follow up review w/in 45-60 days:

Appeal of all denied claims where payment is due
Research coding errors & submit request for change to physician (with manager review).
Contact attorneys for work comp and auto injury claims, filing liens as appropriate
Resubmission of claims when needed

REFUNDS:

Research credit balances, using credit balance or small balance report
Provide supporting documentation to Manager for refunds to be issued. Post refunds to patient's accounts once payment received from Manager and enter notes about details of refund before mailing off.

COLLECTIONS:

Review Collection report and Collection Payment report weekly, submit appropriate accounts to Provider for review.
Report collection payments received promptly to collection agency
Make collection calls as determined by policy, manager or physician.
Send approved accounts to collection agency and adjust account accordingly.

PATIENT BILLING STATEMENTS:

Miscellaneous:

Provide back up for phones as needed (no more than three rings without an answer.)
Provide feedback and training to nursing, reception and billing staff.
Review charges before office visits for past due balances, copays, insurance questions
Superbill maintenance
Keep current on coding and billing rules, attending insurance company workshops and coding seminars as appropriate.
Run computer reports as needed including close of month.
Order and maintain inventory for business office
Perform other duties as assigned including cross-covering Front Desk staff as needed.

Performance Requirements:

Knowledge of coding compliance rules and regulations
Knowledge of billing practices and procedures
Knowledge of insurance carrier requirements
Skills in computer, billing software and calculator
Ability to prepare billing documents, accurately and completely
Success in managing collections and accounts receivable at the patient level
Ability to prepare records effectively for patients, insurance companies and third parties
Knowledge of office policies and procedures
Ability to answer phones, route calls appropriately and perform registration tasks when needed

Supervision Requirements:

Reports directly to Billing Manager.
Responsible for supervising support staff that perform data entry/appeal follow-up, collections, etc.
Responsible for educating Physicians and Ancillary staff on correct billing and coding techniques.
Responsible for notifying all staff when there is an issue occurring or an impending issue that may affect accurate claim submission.