RCM A/R Specialist/Coder Job in Torrance, California

POSITION SUMMARY:

The RCM Account Receivable Coder Specialist is responsible for timely and appropriate billing, coding and collection of monies from payors and/or patients.

ESSENTIAL FUNCTIONS:

• Follows-up on all assigned accounts from within the billing systems in accordance with pre-established goals.
• Initiates proactive measures that result in account resolution.
• Researches and analyzes accounts and payments; reverses balances to credit or debit if charges were improperly billed or if payments were incorrect.
• Ensures that all coding conditions for billing have been satisfied, which incudes, but is not limited to, accurate charges and financial class; benefit confirmation, ICD-10 and CPT-4 Coding
• Responds timely and accurately to all incoming coding reviews requests and inquiries from management, physicians, A/R, and other appropriate parties.
• Initiates appropriate recommendations and action plans for resolving coding denials accounts.
• Initiates physician education, as necessary.
• Evaluates accounts to determine any write-offs or corrections required, including duplicate charges.
• Responds to all phone calls from other departments or insurance companies in an efficient and courteous manner
• Writes appropriate notes in billing system for every account, including any action taken.
• Handles in a professional and confidential manner all correspondence, documentation, and files.
• Reviews various reports to identify denials and edits; corrects claims; suggest action plans to eliminate these denials/edits in the future; determines appropriateness for appeal.

Customer Service:

• Receives and answers coding related inquires or complaints from coworkers and management concerning self-pay accounts, gathers information for timely resolution of issues.

Communication:

• Works with co-workers in the RCM department and others to obtain required information on a timely basis and to solve outstanding issues, as appropriate.

• Supports Skyline Urology’s core values, policies, and procedures.
• Works on special projects and other duties as assigned by supervisor or management

COMPETENCIES AND SKILLS:

• Effective oral and written communication skills
• Filing, planning ,organization skills, and time management skills
• Proficient Microsoft Office skills required (i.e. Microsoft Word, Excel, PowerPoint, etc.)
• Customer Services Skills            
• Knowledge of different insurance types; plans, products and their specific coding guidelines
• Knowledge of billing practices and clinical policies and procedures
• Ability to understand and interpret payer policies and regulations
• Ability to examine documents for accuracy and completeness
• Strong knowledge of CPT and ICD coding (CPT-4 and ICD-10 coding)
• Understanding of insurance billing and collection requirements
• Knowledge of procedures and data flow in a healthcare organization

• Knowledge of HIPPA and PIH
• Excellent verbal and written communication skills in the English language
• Able to work in team-oriented environment.
• Ability to work independently and to be proactive in securing payments and resolving issues

EXPERIENCE AND/OR EDUCATION:

• High School Diploma or equivalent required
• CPC certification required
• Medical Billing Training and/or Certificate is preferred
• 2 years’ experience in the medical field required, urological experience preferred
• EMR and Practice Management (Centricity) system experience
• Experience with charge entry and billing in medical office setting
• Experience handling complex accounts
• Experience with physician billing preferred