Senior Outpatient Billing Specialist – Full Time
Job description
Responsible for the billing of complex outpatient facility and professional insurance claims. Reviews electronic medical health records in eClinicalWorks (eCW) for completeness, accuracy, and compliance with CMS regulations prior to claim submission. Works closely with Sr. Coding Specialist to troubleshoot and identify the root cause of insurer payment delays, denials, and rejections. Successful candidates will have high volume experience both in NYS Article 28 Ambulatory Surgical Center billing, as well as Article 28 clinic billing. They will ensure all processes are in accordance with the mission, core values, and purposes of the organization.
Experience:
- Facility and professional billing and coding experience a must
- Outpatient/ASC billing and coding experience a must
- Skilled in optimizing billing systems for cost savings
- Experience with eClinicalWorks EMHR strongly preferred
- Experience with doc-tor.com billing platform a big plus
- Experience working with Medicaid and Managed Medicaid insurance carriers a must
- Working knowledge of NYS DOH ePaces claim submission platform a big plus
- Denials research, appeals, and rebilling experience a must
- Comprehend insurance Explanation of Benefits (EOB’s) from various insurance carriers
- Posting cash receipts from paper remittances as well as ERAs
- ICD-10, NY-APG, and CPT coding knowledge
- Insurance verifications experience strongly preferred
- Registration and admitting process knowledge a big plus
Responsibilities:
- Assist in-house Sr. Outpatient Coding Specialist with ensuring patient encounters in EMHR platform are coded appropriately
- Monitoring claim activity, examine insurance EOBs, and posting of paper and electronic insurance remittances
- Address billing issues as they occur, identify incorrect billing, and recommend solutions to prevent going forward.
- Ensure compliance and integrity of data with billing and regulatory requirements. Continuously look for areas to improve existing processes
- Detect errors in billing processes and suggest appropriate corrections
- Perform analytical review of denials and payment variances. Determine the reasons for denials, discuss with outside billing company, assist in correct claim file. Also assist with appeal denials and perform appropriate insurance company follow up.
- Create trending reports of all high-volume denials and payment variances and prepare and submit progress reports to billing company and CFO
- Perform reimbursement management, analyze payer reimbursement to ensure proper claim adjudication, and track and report on high volume payment discrepancies.
- Able to perform all other billing functions/tasks and other duties as assigned by Sr. Coding Specialist and CFO.
- Conforms to all applicable HIPAA, Billing Compliance and safety policies and guidelines.
- Adheres to agency policy, procedures, and the professional code of ethics.
Qualifications
- Medical Billing and Coding: 5 years
- ICD-10, NY-APG, and CPT: 5 years
- eClinical Works EMHR Platform : 2 years (strongly preferred)
- Doc-tor.com Billing Platform: 2 years (a big plus)
- ePaces NYS DOH Claims Platform:1 year (a plus)
- Proficient in Excel (Required)
- Excellent communication and organizational skills
- Must be able to work well in a fast-paced, professional environment.
License/Certification:
- AAPC, AHIMA or NHA Medical Billing Certification (strongly preferred)
Pay Rate:
Based on experience and qualifications
Benefits:
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
- 401k
Job Type
Schedule:
- Monday to Saturday Hourly Flex Schedule
Work Location:
· Onsite to start. Hybrid arrangement possible after 6 months
Please visit our site: choiceswomensmedical.com
Pay: From $32.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Work Location: Hybrid remote in Jamaica, NY 11435
