Experience - Multi-disciplinary clinic who works with UHC, BCBS, Tricare, Aetna, Cigna, Optum, Worker's Comp & Medicare insurnaces

PRIMARY EXPECTATIONS:

The Medical Billing/Coding Specialist at Thrive Proactive Health, serves a key role in Revenue Cycle Management (RCM). This team member will need to be detailed oriented and work closely with our front end team and billing software to manage the claims process, assure accurate and timely follow-up and correspondence withproviders, insurance payers, and 3rd party billing company. This role will potentially be working within multiple software systems, and will monitor and analyze reports that will help to identify deficiencies and improve how claims are being submitted, payments are posted, denials, appeals and collections are managed. This position will also assist patients with their financial responsibilities by providing patient centered customer service and helping with the collections process. Other important duties may include organizing and understanding insurance contracts, enrollment, credentialing and attestations. 

PRIMARY RESPONSIBILITIES

• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
• Prepares and submits clean claims to third party payers either electronically or by paper.
• Issues adjusted, corrected, and/or rebilled claimsto third partypayers.
• Maintains relationship with Practice Pro Billing Department, including appropriatefollow-up with support issues. 
  • Communicates with Practice Pro on a regular basis on all platforms, including ShareFile, Active Collab, and the Practice Pro dashboard.
• Manage monthly statement process, to include reviewing statements before mailing and field any patient inquiries the PatientServices staffneeds to escalate.
• Works with Front End Team to ensure appropriate collection of co-pay, co-insurance, and deductibles are accurate and self pay fees. 
  • Coordinate collection process, to include any projects from Practice Pro accounts and tracking current collections in Practice Pro.
• Handles patient inquiries and answers questions from clerical staff and insurance companies.
  • Answering all patient or insurance telephone inquiries pertaining to assigned accounts.
• Reviewing patient bills for accuracy and completeness, and obtaining any missing information.
• Denial and insurance follow-up management.
• Posts adjustments, transfer of responsibility and refunds, as necessary.
• Assure Coding is compliant and up to date.
• Reviews accounts and makes recommendations to the COO regarding non collectible accounts. 
• Calling insurance companies regarding any discrepancy in payments if necessary.
• Identifying and billing secondary or tertiary insurances.
• Reviewing accounts for insurance of patient follow-up.
• Researching and appealing denied claims.
• Setting up patient payment plans and work collection accounts.
• Updating billing software with rate changes according to fee schedules 
• Updating spreadsheets and running collection reports.
• Obtaining referrals and pre-authorizations as required for procedures.
• Checking eligibility and benefits verification for treatments, hospitalizations, and procedures.
• In addition to these general duties, an individual employer may request that you perform other duties that fit with your training and background experience or provide further training for new duties.

Basic requirements typically listed include:

• Previous medical billing experience including knowledge of billing related reporting;3- 5 years’ experience in health-care billing & collection practices.
• Experience working with medical payers includingMedicare, Tricare, and other commercial insurances
• Working knowledge of medical billing systems, particularly Practice Pro, 
• Experience with Medicare’s State Eligibility System
• Working knowledge of CPT and ICD-9 & ICD-10 coding systems; Coding certificationpreferred
• An Associate Degree from an accredited universitywith credentials in billing/codingpreferred
• Excellent organizational skills
• Self starter
• Proficiency in G-Suite