- Verifies insurance and registration data for scheduled office, outpatient, and 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. Proficient in moderate to complex encounters and problematic accounts.
- Works daily Accounts Receivable accounts via online workfile 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.
- Analyzes claims system reports to ensure underpayments are correctly identified and collected from key carriers. Reviews and resolves billing issues and provides recommendations.
Identifies and resolves credentialing issues for department physicians.
Meets with practice management, leadership and/or physicians on a scheduled basis to review Accounts Receivable and current billing concerns.
Mentors less experienced Billing staff and assists Billing Manager/FPA Manager in training new staff.
May approve EPIC work queue for outpatient encounters
May approve Patient Keeper work queue for inpatient encounters.
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 prepare TOS deposits in Sinai Central.
Maintains working knowledge and currency in third party payor requirements.
- Associates Degree or high school diploma/GED plus 3 years of relevant experience
- 3 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
- CPC preferred