Cycle Medical Billing

Description

Charge Entry Portion:

Post charges daily

Reviews charges for correct coding

Audit codes for potential missed charges

Preparing, reviewing, and transmitting claims using billing EMR

Reconcile missing encounters

Prior Auth Portion:

Review EMR chart messaging and review schedules daily for upcoming surgical & in office procedures

Review chart documentations to ensure patient meets medical policy guidelines

Prioritize authorization request according to urgency

Obtain authorization via payer website or by phone and follow up regularly on pending cases

Verify coverage and benefits and calculated any out-of-pocket portions due

Contact patients to review any out-of-pocket portions due prior to surgery

AR Follow Up Portion:

-Resolve errors and make claim edits assigned in work buckets

-Follow work list prioritization of accounts as established by department policies and procedures for resolving accounts and/or submitting claims

-Contact payers and patients when necessary

-Request relevant information from appropriate Revenue Cycle and clinical departments as required through the course of the PFS Processes

-Make necessary adjustments to patient demographic, insurance, and account balance information

-Complete A/R adjustments where permitted and appropriate: request other adjustments were permitted and appropriate

-Comply with and adhere to all regulatory compliance areas, policies and procedures (including HIPAA and PCI compliance requirements) , and leading practices

Qualifications

Requirements

Minimum 1 year charge posting, prior authorization and AR follow up experience

Understanding of payer medical policy guidelines to manage authorizations effectively

Proficient use of CPT and ICD
10 codes

Detail oriented and above average organizational skills

Plans and prioritizes to meet deadlines

Ability to multitask and remain focused while managing a high volume, time sensitive workload

Interventional Radiology (IR) experience helpful

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