Procedural Billing Specialist I - Axelon Services Corporation

Job Summary:
-Performs specialized coding services for inpatient and outpatient medical office visits. Reviews physician coding and provides updates.
-Provides comprehensive financial counseling to patients. Responsible for setting patient expectations, discussion of financial options, payment plans, one-time settlements and resolution of unpaid balances.
-Discusses with patients the details concerning their insurance coverage and financial implications of out-of-network benefits, including pre-determination of benefits, appeals and/or pre-certification limitations.
-Develop and manages fee schedules and for self-pay patients.
-Processes Worker s Compensation claims and addresses/resolves all discrepancies.
-Conducts specialized negotiations with insurance companies. Brokers and negotiates with insurance carriers. Establishes a network of key representatives within the insurance pre-certification units to establish open lines of communication for future service negotiation.
-Verifies insurance and registration data for scheduled office, outpatient, and inpatient procedures. Reviews encounter forms for accuracy. Responsible for obtaining pre-certifications for scheduled admissions.
-Enters office, inpatient, and/or outpatient charges with accurate data entry of codes.
-Posts all payments in IDX. Runs and works missing charges, edits, denials list and processes appeals. Posts denials in IDX on a timely basis.
-Provides comprehensive denial management to facilitate cash flow. Tracks, quantifies and reports on denied claims.
-Directs and assists with responses to problems or questions regarding benefit eligibility and reimbursement procedures.
-Researches unidentified or misdirected payments.
-Works credit balance report to ensure adherence to government regulations/guidelines.
-Analyzes claims system reports to ensure underpayments are correctly identified and collected from key carriers. Reviews and resolves billing issues and provides recommendations.
-Identifies and resolves credentialing issues for department physicians.
-Maintains a thorough understanding of medical terminology through participation in continuing education programs to effectively apply ICD-10-CM/PCS, CPT and HCPCS coding guidelines to inpatient and outpatient diagnoses and procedures.
-Meets with practice management, leadership and/or physicians on a scheduled basis to review Accounts Receivable and current billing concerns.
-Mentors less experienced billing staff and assists Billing Manager/Revenue Cycle Manager in staff training.
-Other identified duties as assigned.