Job description

GENERAL SUMMARY OF DUTIES:

Primarily responsible for coding procedures and maintaining credit and collection policies and accurate accounts receivable for the Private practice. Responsible for supervising the insurance reimbursement functions of the Private practice. In addition, crossed trained to provide support Surgery Center functions such as bill, coding and insurance verification.

SUPERVISION RECEIVED: Reports to Administrator/Chief Financial Officer

TYPICAL PHYSICAL DEMANDS:

Frequent mobility and/or sitting required for extended periods of time. Bending, stair climbing, and stooping required. Requires occasionally lifting up to 50 pounds of boxes or paper. Requires manual dexterity to operate keyboard, calculator, photocopy machine and other equipment. Required eyesight correctable to 20/20 to read numbers, policies, and computer terminals. Requires hearing within normal range for telephone use. Occasional high stress work may require dealing with angry people.

TYPICAL WORKING CONDITIONS:

Work is performed in an office environment. Frequent contact with employees and outside agencies. Continual patient contact may involve dealing with angry or upset patients.

GENERAL DUTIES: (This list may not include all of the duties assigned)

The daily coding of insurance services performed in the APS. This encompasses billing and coding functions for this company.

Data entry of APS visits and surgeries into PatientNow for APS.

Electronic Claim Submission (BS & Medicare) and all paper claim submission on a daily basis according to prior billing policy, which is subject to adjustment.

Produces and sends all statements on a monthly basis for APS.

Posts all insurance payments for the APS.

Responsible for AR balancing and closing for the APS.

Researches all information needed to complete billing process, including obtaining coding information from physicians.

Monitors aging reports and assures that policies are being followed and follows up on accounts until 0 (zero) balance or account is turned over to collection.

Coding and Error resolution.

Ensures that State and Federal guidelines from billing third party carriers are being followed.

Review reimbursements from third party payors to ensure payment through proper use of codes.

Adheres to fee schedules for Medicare, Blue Cross Blue Shield, and all managed care contracts to ensure proper payment for services is achieved.

Monitors Medicare Reimbursements.

Assists as a backup with verifying insurance benefits for surgical patients including checking coverage and authorizations. Responsible for notifying patients of any deductible or copay due date of service.

Any additional duties as deemed necessary by administration.

Maintains procedure code master file. Evaluates and develops new entries.

Maintains diagnosis code master files including identifying inappropriate codes and informing appropriate medical staff.

Monitors all payor classes including HMO’s, PPO’s, and Worker’s Compensation reimbursement and maintains files.

Responsible for being up-to-date and knowledgeable of coding and diagnostic procedures, as well as remaining current about federal legislative changes that affect outcomes.

Maintains strictest confidentiality.

Assists in processing refunds to patients and insurance companies for overpayment.

Assists in maintaining medical records.

Cross training with the ASC billing

PERFORMANCE REQUIREMENTS:

Knowledge, Skills & abilities:

Knowledge of coding policies and procedures, reimbursement practices. Knowledge of coding and clinic operating policies. Skill in using computer and appropriate computer programs. Ability to examine documents for accuracy and completeness. Ability to prepare records in accordance with detailed instructions. Ability to work effectively with medical, administrative staff, patients, and co-workers. Ability to communicate clearly. Knowledge of organization policies and procedures. Knowledge of healthcare administrative practices. Knowledge of medical quality assurance principles and systems. Knowledge of statistical and computer modeling techniques. Skill in gathering, interpreting and reporting information. Skill in trouble-shooting quality assurance problems. Ability to identify problems and recommend solutions.

Proficiency in filing insurance claims. Knowledge of word processing. Knowledge of commercial, Medicare, and HMO procedures. Knowledge of coding. Knowledge of compliance and cost reimbursement. Ability to maintain confidentiality of sensitive information. Ability to process patients and agency inquiries. Ability to recognize, evaluate, solve problems and correct errors. Skill in establishing and maintaining effective working relationships with other employees, patients, insurance organizations and the public. Knowledge of electronic claims submission.

EXPERIENCE: Two years of experience with coding practices in a medical facility.

Two years experience in peer review, quality assurance responsibility.

ALTERNATIVE TO MINIMUM QUALIFICATIONS:

Additional appropriate education may be substituted for two years’ experience.

Job Type: Full-time

Pay: $35,000.00 - $46,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Employee discount
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Ability to commute/relocate:

• Greensburg, PA 15601: Reliably commute or planning to relocate before starting work (Required)

Experience:

• ICD-10: 2 years (Preferred)

Work Location: One location

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