Medical Biller/Billing Specialist/Medical Coder
This is a perfect opportunity for nurses who have shifted their careers in office administration rather than hospital/clinic setting.
The main responsibility is taking a provider’s diagnostic and procedural notes and converting them into the correct codes for record-tracking and billing purposes. To succeed in this role, you must possess in-depth knowledge of billing software and medical insurance policies. The ideal candidate must also be able to demonstrate excellent written and verbal communication skills, as communicating with clients and various insurance agents will form a large part of the job.
Duties and responsibilities:
– Assign codes to diagnoses and procedures, using ICD (International Classification of Diseases) and CPT (Current Procedural Terminology) codes
– Ensure codes are accurate and sequenced correctly in accordance with government and insurance regulations
– Accounts for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications.
– Assigns codes for reimbursements, research, and compliance with regulatory requirements utilizing guidelines.
– Obtaining referrals and pre-authorizations as required for procedures.
– Checking eligibility and benefits verification for treatments, hospitalizations, and procedures.
– Reviewing patient bills for accuracy and completeness, and obtaining any missing information.
– Preparing, reviewing, and transmitting claims using billing software, including electronic and paper claim processing.
– Checking each insurance payment for accuracy and compliance with contract discount.
– Prepare and submit billing data and medical claims to insurance companies.
– Prepare bills and invoices, and document amounts due to medical procedures and services.
– Help patients develop patient payment plans.
– Ensure the patient’s medical information is accurate and up to date.
– 3-5 years of experience in all areas as a Medical Biller and Medical Coder
– Should be proficient w/ CPT, ICD10, modifiers, charge entry
– Experience in payment posting, denials/rejections, AR management.
– Solid understanding of billing software and electronic medical records.
– Patient/client interface is a plus.
– Registered Nurse a plus