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SUMMARY
In-depth knowledge of Procedural Coding. Specialist in identifying appropriate ICD-10 coding based on CMS/HCC categories, CPT, HCPCS and CMS guidelines. Knowledge in processes for Super Bill, Electronic Claims Submission, Clearing House Operations, EOB, patient payments, denials, appeals, referrals, and authorizations.
QUALIFICATIONS/EDUCATION
High School Diploma or equivalent Bi-lingual English/Spanish preferred; must be able to read, write and speak fluent English. 1-2 years of experience in Customer Service preferred Basic computer knowledge; MS Word and MS Excel, internet, document with Electronic Health Records and/or authorization system with minimal typing/spelling errors, send e-faxes and email. Strong people skill; independent decision making and customer service oriented. Billing and/or referrals experience preferred.
CERTIFICATIONS/LICENSES
CPC, CCS, or NCCT Certified-Preferred
ABILIITES/SKILLS Basic computer skills to be able to recognize and understand our appointment system. Excellent communication, Customer Service and telephone skills. Cheerful, pleasant, knowledgeable and professional demeanor, must always display a smile. Strong organizational skills and ability to multi-task effectively. Detail oriented and able to work efficiently in a stressful environment. Strong sense of teamwork and be able to manage high volume of interpersonal relationships with tact and diplomacy. Must be able to work independently and relate well with all levels of individuals within the organization. Able to respect and maintain patient confidentiality at all times. Must be able to follow policies and procedures and work flexible schedule and location. Must be able to work with the Practice Management and/or Electronic Health Record System.
SUPERVISORY RESPONSIBILITIES
N/A
ESSENTIAL DUTIES AND RESPONSIBILITIES Data entry in HER and payer portals. Obtain authorizations for Specialty encounters. Reconciles daily encounter activity, authorizations, billing. Review medical records to identify appropriate ICD-10 and CPT coding based on CMS categories. Creating and submitting insurance claims to different insurance companies. Process encounters for billing, statements, reimbursement claims, post transaction and data.
Proper documentation to different level of appeals based on insurance denials.
Deals with queries and responds via telephone, portal, or in writing. Must verify insurances as necessary. Communicating with insurance companies for claim(s) payment/denials/rejections. May collect patient payments and ensure payments are properly recorded and processed. Run daily and monthly reports. Conducts all activities in a polite, courteous and professional manner and abides by company policies and procedures. Maintain work area clean and organized at all times. Complies with HIPAA regulations. Fill prescriptions from optometrists and ophthalmologists. Conduct basic eye examinations. Take customers' eye measurements. Assist customers in choosing eyeglasses and frames. Help eye patients decide which lens types are apt for them. Keep customer prescriptions and records up to date in EHR and lab portal. Repair broken or damaged glasses and frames or send them to lab for repair and maintenance. Performs other duties as assigned.
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In-depth knowledge of Procedural Coding. Specialist in identifying appropriate ICD-10 coding based on CMS/HCC categories, CPT, HCPCS and CMS guidelines. Knowledge in processes for Super Bill, Electronic Claims Submission, Clearing House Operations, EOB, patient payments, denials, appeals, referrals, and authorizations.
QUALIFICATIONS/EDUCATION
High School Diploma or equivalent Bi-lingual English/Spanish preferred; must be able to read, write and speak fluent English. 1-2 years of experience in Customer Service preferred Basic computer knowledge; MS Word and MS Excel, internet, document with Electronic Health Records and/or authorization system with minimal typing/spelling errors, send e-faxes and email. Strong people skill; independent decision making and customer service oriented. Billing and/or referrals experience preferred.
CERTIFICATIONS/LICENSES
CPC, CCS, or NCCT Certified-Preferred
ABILIITES/SKILLS Basic computer skills to be able to recognize and understand our appointment system. Excellent communication, Customer Service and telephone skills. Cheerful, pleasant, knowledgeable and professional demeanor, must always display a smile. Strong organizational skills and ability to multi-task effectively. Detail oriented and able to work efficiently in a stressful environment. Strong sense of teamwork and be able to manage high volume of interpersonal relationships with tact and diplomacy. Must be able to work independently and relate well with all levels of individuals within the organization. Able to respect and maintain patient confidentiality at all times. Must be able to follow policies and procedures and work flexible schedule and location. Must be able to work with the Practice Management and/or Electronic Health Record System.
SUPERVISORY RESPONSIBILITIES
N/A
ESSENTIAL DUTIES AND RESPONSIBILITIES Data entry in HER and payer portals. Obtain authorizations for Specialty encounters. Reconciles daily encounter activity, authorizations, billing. Review medical records to identify appropriate ICD-10 and CPT coding based on CMS categories. Creating and submitting insurance claims to different insurance companies. Process encounters for billing, statements, reimbursement claims, post transaction and data.
Proper documentation to different level of appeals based on insurance denials.
Deals with queries and responds via telephone, portal, or in writing. Must verify insurances as necessary. Communicating with insurance companies for claim(s) payment/denials/rejections. May collect patient payments and ensure payments are properly recorded and processed. Run daily and monthly reports. Conducts all activities in a polite, courteous and professional manner and abides by company policies and procedures. Maintain work area clean and organized at all times. Complies with HIPAA regulations. Fill prescriptions from optometrists and ophthalmologists. Conduct basic eye examinations. Take customers' eye measurements. Assist customers in choosing eyeglasses and frames. Help eye patients decide which lens types are apt for them. Keep customer prescriptions and records up to date in EHR and lab portal. Repair broken or damaged glasses and frames or send them to lab for repair and maintenance. Performs other duties as assigned.
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