Remote Billing and Coding Specialist (AR & Claims

Position: Remote Billing and Coding Specialist (AR & Claims)
Position Summary:

The Billing Specialist is responsible for understanding all aspects of coding, quality assurance and compliance with Federal Payer documentation guidelines. This role works closely with departmental management and coordinates with Physicians. Posting, clean claim submission to clearing house, denials, appeals, follow-up on claims until payment received.

Reports to:

Billing Specialist reports directly to the Billing Manager Flexibility:
While this job description is meant to provide an overview and specific responsibilities of the Billing Specialist, ENTA Management reserves the right to make changes, adjustments, and revisions, as needed, to this document and will coordinate such modifications with ENTA’s Practice Administrator and Physicians. While the normal work week is 40 hours, you may be subject to overtime (not to exceed 50 hours per week).Summary

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Specific Duties :

Billing Accounts Receivable Specialist –Uses A/R follow-up systems and reports to identify unpaid claims for collection/appeal

Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer contract.

Review and update patient registration information (demographic and insurance) as needed

Applies appropriate discounts/courtesies based on department policy

Prepares delinquent accounts for transfer to self-pay collection unit according to the follow-up workflow

Prints and mails claim forms and statements

Retrieves supporting documents (medical records, authorizations, etc.) as needed and submits to payers

Appeals reflected claims and claims with low reimbursement

Confirm credit balances and gathers necessary documentation for processing refund.

Identifies insurance issues of primary vs. secondary insurance, coordination of benefits eligibility and any other issues causing non-payment of claims

Monitor invoice activity until problem is resolved

Process daily mail, edits reports, file or pull EOB batches

Identifies and informs Manager of issues or problems associated with non-payment of claims

Contacts payors or patients as appropriate for corrective action to resolve the issues and receive payment of the claims

Billing and Payment Posting Specialist –Maintaining and clearing of exceptions in the Encoda Payment Manager dashboard daily.

Daily review of outstanding checks, calling payers to identify delays and/or processing a replacement check.

Reviewing and completing the weekly statement reports to ensure any monies are moved to avoid unnecessary statement delivery to patients.

Research and answers billing and documentation questions or problems, submitted by staff, billing staff, and others to ensure compliance with specific payer regulations.

Posting of all payments and rejections (manual & electronic) in Prime Suite.

Processing and Handling of all patient and insurance refunds.

Maintain and movement of payments from credit to line-item charges, ensuring patient credit balance accuracy.

Completes daily and month-end closing.

Updates patient demographics for insurance related issues in order to accurately process claims.

Investigating and updating any returned patient statements via mail Billing Charge Entry Coding Specialist-Responsible for all aspects of coding, quality assurance and compliance with Federal payer documentation guidelines.

Serves as departmental expert on coding questions.

Holds bills and seeks corrective action for services not meeting documentation requirements in accordance with polices.

Research and answers billing and documentation questions or problems, submitted by staff, billing staff, and others to ensure compliance with specific payer regulations.

Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payor or contract.

Maintains a system of billing accuracy through encounter verification i.e., clinic schedules, encounter forms, I/P Consults, ER Consults, Surgeries, medical records.

Review and resolve Encoda charge review edits daily.

Charge Entry Maintain and movement of payments from credit to line-item charges, ensuring patient credit balance accuracy.

Compl…