Medical Biller and Coder - Revenue Cycle Specialist

Revenue Cycle Specialist – Plastic & Reconstructive Surgery

The Revenue Cycle Specialist will work in a high-volume, fast-paced physician office environment and will be responsible for performing physician accounts receivable follow-up, contacting payors and patients to ensure maximum reimbursement on claims, investigating and appealing unpaid or denied claims to ensure accounts are worked at a high level of quality and accuracy, and obtaining pre-certifications for surgical procedures,

DUTIES AND RESPONSIBILITIES

• Must have a minimum of five (5) years of physician accounts receivable billing and follow-up experience.
• Must have experience working major insurance carriers including but not limited to:
• UnitedHealthcare
• Cigna
• Blue Cross Blue Shield
• Aetna
• Medicare
• Medicaid
• Responsible for high-level physician accounts receivable follow-up including:
• Filing insurance claims
• Correcting and resubmitting claims
• Appealing denied or underpaid claims
• Working all levels of insurance appeals and reconsiderations
• Filing complaints and disputes with the Texas Department of Insurance (TDI) when appropriate
• Expedites and maximizes payment of medical insurance claims by contacting payors and patients regarding unpaid, denied, or partially paid claims.
• Reviews claims to verify payments are processed according to fee schedules and contractual agreements and ensures appropriate contractual adjustments are taken.
• Collaborates with management and physicians to reduce aging accounts over 90 days through verbal and written communication and proactive follow-up.
• Identifies claims processing issues and communicates findings to management to avoid delays in reimbursement.
• Documents clear, concise, and complete follow-up notes within the system for every account worked.
• Must have extensive surgical pre-certification knowledge with the ability to appeal denied authorizations and coordinate peer-to-peer calls between medical directors and physicians.
• Assures accounts are worked and completed at a high level of quality through detailed review, auditing, and visual proofreading of work output.
• Demonstrates strong working knowledge of Epic and other billing systems.
• Ability to multi-task and work efficiently within multiple databases in a high-volume office environment.
• Maintains professionalism and strong customer service skills when communicating with physicians, staff, patients, and insurance representatives.

EDUCATION REQUIREMENTS

• High School Diploma or GED required
• College degree preferred
• CPC certification preferred

EXPERIENCE REQUIREMENTS

• Minimum of five (5) years physician accounts receivable billing and follow-up experience required
• Preferably within a plastic and reconstructive surgery physician practice
• Strong understanding of physician billing processes, insurance reimbursement methodologies, and third-party payor policies and procedures
• Experience with claim appeals, denials management, surgical authorizations, insurance follow-up, and payment resolution
• In-depth knowledge of CPT and ICD-10 coding
• Proficiency in Microsoft Office Suite and Epic preferred
• Candidate must demonstrate a strong and stable employment history with consistent job tenure in prior healthcare or physician billing positions

SKILLS

• Strong customer service, communication, phone, and scheduling skills
• Extensive knowledge of insurance requirements for physician visits, procedures, and surgical authorizations
• Ability to prioritize workload and manage multiple tasks in a fast-paced environment
• Strong analytical and problem-solving skills related to claim resolution and reimbursement
• Attention to detail with the ability to maintain accuracy and productivity

Job Type: Full-time

Pay: From $28.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person

Salary : $28