Strength Through Diversity
Ground breaking science. Advancing medicine. Healing made personal
Role & Responsibilities:
- Verifies insurance and registration data for scheduled outpatient/inpatient encounters and scheduled surgeries; reviews encounter forms for accuracy. May be responsible for obtaining pre-certification for scheduled surgeries and admissions.
- Enters office, inpatient, and/or outpatient charges with accurate data entry of codes. Ensures charges are entered/processed in accordance with policies and procedures.
- May run and work missing charges, edits, denials list and process appeals. Posts denials in IDX on a timely basis.
- Posts all payments in IDX using approved methodologies.
- May perform specialty coding for services and medical office visits and review physician coding and provide updated to physicians and staff.
- Works TES, BAR and eCommerce edits for the division, department and physicians.
- Works daily Accounts Receivable accounts via online work file and/or hard-copy reports; checks claims status, re-submits claims, and writes appeal letters.
- Researches unidentified checks sent to other departments.
- Works credit balance report to ensure adherence to government regulations/guidelines.
- Identifies billing issues for resolution; may provide recommendations.
- Identifies and resolves credentialing issues for department physicians.
- Meets with practice management or physicians on a scheduled basis to review Accounts Receivable and current billing concerns.
- May be responsible to prepare and verify office hours schedules.
- May be responsible for collection of time of service payments, and maintaining daily transaction record of collected payments.
- May work Patient Keeper work queue for inpatient encounters.
- May approve EPIC work queue for all outpatient encounters.
- May prepare TOS deposits in Sinai Central.
- Maintains working knowledge and currency in third party payor requirements.
- Associates Degree or high school diploma/GED plus 2 years of relevant experience, CPC preferred
- 2 years experience in medical billing or health claims, with experience in IDX billing systems in a health care or insurance environment, and familiarity with ICD/CPT coding