Billing, Communication Skills, Current Procedural Terminology (CPT), Electronic Medical Records, Establish Priorities, HIPAA (Health Insurance Portability and Accountability Act), Healthcare Providers, High School Diploma, ICD-10, Insurance, Keyboards, LCD (Liquid Crystal Display), Lift/Move 25 Pounds, Medical Billing, Medical Coding, Medical Equipment, Medical Terminology, Mentoring, Multitasking, Physical Demands, Reconciliation, Regulations, Reimbursement, Telephone Skills
- Reviews progress notes to determine codes meet local and national medical necessity guidelines.
- Assigns ICD-10 and CPT codes with the appropriate modifiers for services provided when posting charges.
- Be familiar with medical terminology, LCD’s, NCD’s and insurance portals to stay compliant with industry coding practices. .
- Monitor payer EOB’s/system for denials and improper payments.
- Investigate and follow up on denied or rejected claims by sending corrected claims/appeals and contacting insurances as necessary.
- Follows all HIPAA regulations and upholds the highest standards of privacy and confidentiality.
- Answer phones and handle patient calls regarding accounts for billing, as needed.
- Key claims on MaineCare portal, as needed.
- Verify insurance coverage and benefits prior to submitting claims to ensure proper reimbursement.
- Collect, post and manage patient account payments
- Collaborate with healthcare providers to resolve any discrepancies in billing or coding as requested by Billing Manager.
- Actively participates in department meetings, one-on-one meetings and mentorship meetings with billing team members.
- Serve as a resource and subject matter expert to other staff members (front office, providers, fellow team members).
- Perform other related duties as requested.
Education and Experience:
- Certification as a Professional Coder is preferred or a combination of education and/or experience in Medical Billing and Coding.
- High School Diploma or G.E.D.
- 1-2 years of experience in the field preferred.
- Able to have good communication skills with staff, clients, insurance companies, and the general public.
- A certain degree of creativity is expected.
Essential Functions:
COMPREHENSION: Understands and applies non-routine verbal and/or written instructions.
ORGANIZATION: Organize and prioritize individual work schedule to manage multiple task and/or projects
DECISION MAKING: Makes decisions that have an impact on the immediate work unit’s operation and/or services.
COMMUNICATION: Communicates and explains a variety of information
PHYSICAL REQUIREMENTS: keyboard operation and sitting for extended periods of time. Ability to lift 25 lbs.; Walking/Standing/Bending/Kneeling/Squatting; Visual acuity for extended periods of monitor operation. Ability to use interfaced communication devices (Electronic Medical Record, telephone, internet, etc.)
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Eastport Health Care, Inc.