Certified Billing & Coding Specialist

SUMMARY: Requires knowledge of ICD-10 coding, accurate typing skills, computer knowledge, prior utilization of an Electronic Medical Record system, knowledge of medical terminology, and the ability to communicate effectively with physicians, co-workers, insurance plan representatives and attorneys. 

DUTIES AND RESPONSIBILITIES:

• Identify billing errors for corrections and resubmit claims to insurance carriers. 
• Follow up on payment errors, low reimbursement, and denials. 
• Compile, code, and submit patient insurance claims to insurance companies as well as follow up on all claims from charge entry through resolution. 
• Review insurance EOB’s and initiate appeals as necessary.
• Respond and appeal to medical necessity denials. 
• Updating system errors, noting system, researching insurance guidelines.
• Follow protocol to determine best course of action to follow up on open receivables.
• Research root issue of denial. Apply knowledge of payer policies to pursue proper course of appeal or follow up to obtain payment.
• Review account history for continuous follow up. 
• Contact insurance companies and/or patient/guarantor through phone contact, correspondence, online portals and other approved means to obtain status of outstanding claims and submitted appeals. 
• Documents clearly in billing system the claim issue and course of action taken on every account worked. Documentation and action must be clearly noted for future follow up and review. 
• Escalate issues and problems to supervisor as appropriate. 
• Identify trends or patters of persistent problems. 
• Perform charge corrections based on payer and institutional policies. 
• Negotiate out-of-network reimbursement, based on determined criteria for max reimbursement.
• Perform other related duties as assigned by management. 

QUALIFICATIONS: 

• High school diploma or equivalent.
• Certified Billing and Coding Specialist Certification required.
• Certified Professional Coder Certification (CPC) from AAPC required.
• Three to five years experience with ICD-10, insurance collections and processing out-of-network claims.
• Excellent written and oral communication skills.
• 10-key by touch; keyboarding speed of at least 50 wpm.
• Knowledge of medical billing terminology.
• Ability to perform diversified clerical functions and basic accounting procedures.
• Ability to effectively communicate with people at all levels and from various backgrounds.
• Commitment to excellence and high standards.
• Strong organizational, problem-solving, and analytical skills.
• Ability to manage priorities and workflow.
• Acute attention to detail.
• Ability to work independently and as a member of various teams and committees.
• Proven ability to handle multiple projects and meet deadlines
• Bilingual skills a plus.

BENEFITS:

• Competitive salary and benefits package
• Health, dental, and vision insurance
• Retirement Plan
• Employee Assistance Program
• Paid Time Off
• Opportunities for professional development and growth
• Collaborative and supportive work environment

Progressive Spine & Orthopaedics is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.