What are the responsibilities and job description for the CDI Specialist position at Community Medical Group?
Summary
The Billing coordinator will review patient medical records and assign codes to diagnoses and procedures performed so the facility can bill insurance and other third-party payers (such as Medicare or Medicaid) as well as the patient.
Duties and Responsibilities
Determine patient invoice by capturing services noted in patient chart; clarifying services with physicians.
Identify responsible party by examining patient record.
Issue invoice by entering service data; calculating charges; mailing invoices.
Resolve billing issues by discussing contract with third-party payer; explaining insurance contract with patient; negotiating settlement.
Review and evaluation tool for accuracy and adherence of medical encounters to accepted national industry standards, plan benefits and authorization guidelines.
Maintain patient and invoice files by entering and adjusting data.
Provide billing information by collecting, analyzing, and summarizing third-party billings, accounts pending, and late charges data and trends.
Assist with credentialing process for onboarding physician(s).
Following up with insurances to ensure physician(s) added to the group contract.
Maintain physician credentialing files.
Assist with data entry as needed.
Assist with patient billing inquiry.
Preform other duties as needed.
Qualifications
Education/Experience:
Must have High School diploma or equivalent.
Certified in Medical Billing and Coding
Experience with Medicaid and Medicare preferred.
MS Office programs experience (Word, Excel, PowerPoint, etc.)
At least one year of experience in billing and coding
Skills:
Experience reporting research results and Analyzing Information
Experience using HEDIS measurements
Data Entry Skills
Thoroughness and attention to detail
Use relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards.
Ability to work independently and to carry out assignments to completion within parameters of instructions given, prescribed routines and standard accepted practices.
Ability to work with individuals within and outside the organization, in professional and courteous manner.
Demonstrated ability to successfully plan, organize and manage projects.
Understand written sentences and paragraphs in work related documents.
Organized and able to manage competing priorities.
Resourcefulness in problem solving.
Actively look for ways to help people.
Strong written and verbal communications skills.
Strong organizational and interpersonal skills.
Excellent customer service skills.
Must be highly flexible; able to accommodate changing needs of the department.
Knowledge of computerized data management system, statistics principles and the ability to quickly develop in proficiency to meet the demands of the position.
Bilingual skills preferred (English/Spanish or English/Creole).