Procedural Billing Specialist I
: Job Details :

Position: Procedural Billing Specialist ILocal Pay Rate: $20/hrLocation: New York, NYHours Per Week: 37.50Hours Per Day: 7.50Days Per Week: 5.00Schedule Notes: 9am-5pm M-F- Urology coding experienceJob Summary:-Performs specialized coding services for inpatient and outpatient medical office visits. Reviews physician coding and provides updates.-Provides comprehensive financial counseling to patients. Responsible for setting patient expectations, discussion of financial options, payment plans, one-time settlements and resolution of unpaid balances.-Discusses with patients the details concerning their insurance coverage and financial implications of out-of-network benefits, including pre-determination of benefits, appeals and/or pre-certification limitations.-Develop and manages fee schedules and for self-pay patients.-Processes Workers Compensation claims and addresses/resolves all discrepancies.-Conducts specialized negotiations with insurance companies. Brokers and negotiates with insurance carriers. Establishes a network of key representatives within the insurance pre-certification units to establish open lines of communication for future service negotiation.-Verifies insurance and registration data for scheduled office, outpatient, and inpatient procedures. Reviews encounter forms for accuracy. Responsible for obtaining pre-certifications for scheduled admissions.-Enters office, inpatient, and/or outpatient charges with accurate data entry of codes.-Posts all payments in IDX. Runs and works missing charges, edits, denials list and processes appeals. Posts denials in IDX on a timely basis.-Provides comprehensive denial management to facilitate cash flow. Tracks, quantifies and reports on denied claims.-Directs and assists with responses to problems or questions regarding benefit eligibility and reimbursement procedures.-Researches unidentified or misdirected payments.-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.-Maintains a thorough understanding of medical terminology through participation in continuing education programs to effectively apply ICD-10-CM/PCS, CPT and HCPCS coding guidelines to inpatient and outpatient diagnoses and procedures.-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/Revenue Cycle Manager in staff training.-Other identified duties as assigned.Skills:Required Skills & Experience:-Excellent organizational skills.-Excellent communication and customer service skills.-Knowledge of medical terminology and anatomy.-Strong attention to detail and ability to multitask.-Excellent calculation, verbal and communication skills.-Strong ability in analysis and research.Preferred Skills & Experience: