SUMMARY: Submission of claims with supporting documentation as necessary, posting of payments and patient account follow up. Accounts receivable monitoring, working denials, appeals and collections. Maintaining up-to-date data regarding payer authorization and billing requirements as well as current fee schedules.
Duties and Responsibilities include the following. Other duties may be assigned.
- Coding and billing of spine surgery and office visit claims.
- Working with multiple payer types including Medicare, Commercial Insurance, Worker’s Compensation, and Auto PIP claims.
- Follow up on claim denials and appeals as well as outstanding patient balances.
- Research patients’ benefits and financial responsibility and communicate with patients about required payments.
- Obtain authorizations for surgeries and procedures.
- Schedule surgeries with the hospital and enter all information into the hospital electronic portal.
- Ensure patients have met all requirements for surgery such as pre-certification, medical clearances, and payment of co-insurance.
- Submit supporting medical records in response to Payer requests for additional information.
- Answering billing questions from patients over the phone or in person.
- Extracting and monitoring Accounts Receivable reports from EMR/PM system.
- Appeals of denied surgery claims.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
At least three years of experience in medical coding and billing required; orthopaedic and spine experience preferred. Associate’s degree (A.A.) or equivalent from two-year college or technical school; or three years related experience and/or training; or equivalent combination of education and experience.
Ability to read and interpret documents. Ability to write routine reports and correspondence. Ability to speak clearly and effectively with patients, physicians and co-workers; before groups or customers or employees of organization.
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, and percentages. Ability to apply concepts of basic algebra and geometry.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form.
To perform this job successfully, an individual should have knowledge of Microsoft Word; Excel; internet software and EMR experience.
Typing >45 WPM
Reading and interpretation skills
Oral and written communication
Attention to detail
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
All employees have a responsibility to comply with our organization’s policies and procedures, code of conduct and confidentiality regulations.