Summary of Duties: This position is an integral part of
the central billing function of the Practice; Responsible for collecting,
posting and managing account payments; Responsible for submitting clean claims
and following up with insurance companies; Evaluates medical record
documentation and charge ticket coding to optimize reimbursement and minimize
claim denial; Reports directly to the Physician or Billing Supervisor (if
Prepares and submits clean claims to various
insurance companies electronically (or by paper).
Evaluates medical record documentation and
charge ticket coding to optimize reimbursement by ensuring
that diagnostic and procedural codes and other documentation accurately reflect
and support the patient visit, and to ensure that data comply with legal
standards and guidelines.
Interprets medical information such as diseases
or symptoms, and diagnostic descriptions and procedures for a given visit in
order to accurately assign and sequence the correct CPT-4 and ICD-9 codes.
Reviews Medicare reimbursement claims (and all
other insurance claims) before submission for completeness and accuracy and to minimize
Prepares, reviews, and sends patient statements.
Accurate data entry of patient demographic
information, charge entry, and posting receipts, adjustments and reserves in
accordance with EOBs and patient checks.
Reviews and processes insurance payments
verifying that insurance companies are paying according to their fee schedules.
Performs banking activity by balancing cash
drawer, preparing daily bank deposits, securing monies collected.
Performs various collection actions, including
contacting patients by phone, until there is no balance.
Investigates and follows up of all outstanding
accounts including collections and denials.
Prepares information for the collection agency.
Evaluates patient’s financial status and
establishes budget payment plans. Follow up and reports status of delinquent
Resolves problems with NSF, bankruptcy, and returned
Has working knowledge of various insurance plans
and collects co-pays and deductibles as indicated by third party payors.
Understanding of computer system in order to
assist patients with billing problems.
Ability to interact appropriately with difficult
patients in an attempt to resolve any questions regarding charges or payments.
Communicates documentation discrepancies, coding
definitions and questions to medical staff for clarification.
Performs coding and documentation quality
Evaluates records and prepares reports, on such
topics as number of denied claims or documentation or coding issues, for review
Posts all charges and office visit payments
within 24 hours of receipt.
Responsible for professional atmosphere to
include appropriate attire and neat, well organized working area.
Other Job Responsibilities:
Ability to assist in other job duties related to
Performs daily backups on office computer
Participates in educational activities and
attends routine staff meetings.
Conducts self in accordance with RFH’s Employee
Establishes and maintains a professional working
relationship with all staff and physicians.
Maintains strict confidentiality; adheres to all
Accepts other duties as assigned.
High School Diploma or GED.
Possession of an Accredited Record Technician’s
certification (ART) or Certified Coding Specialist designation (CCS) issued by
the American Health Information management Association; or two (2) years of
experience in medical record billing and coding.
Knowledge of medical billing, coding and collection
Knowledge of computer programs, Medware (or
Knowledge of Common Procedural Terminology (CPT)
and International Classification of Diseases (ICD-10) and Health Care Procedural
Coding System (HCPCS) coding guidelines
Knowledge of medical terminology; anatomy and
Knowledge of Medicare reimbursement guidelines;
and third-party operating procedures and practices including comprehension of
explanation of benefits (EOBs).
Knowledge of business office procedures.
Ability to operate a computer and basic office
equipment; multi-line telephone system.
Ability to research and analyze data, resolve
issues; read and interpret medical procedures and terminology.
Must be multi-tasking, well organized, and