Responsible for timely, accurate, and comprehensive billing of provider services using appropriate CPT, HCPCS, and ICD-10 diagnosis codes. Prepares and submits clean claims to Medicare, Medicaid, commercial insurance carriers, and self-pay patients, and works claim rejections.
Duties
- Submit claims to payers based on review of medical records and in accordance with Medicare, Medicaid, and commercial insurance guidelines and organizational policies.
- Review patient, insurance, diagnosis, treatment code, modifier, and provider information to ensure clean claim submission.
- Enter charges accurately and promptly to support proper record handling and fast payment.
- File insurance claims to clearinghouses or individual insurance companies electronically or on paper.
- Review and correct claim edits received from the clearinghouse and internal claims scrubber within 24 hours.
- Initiate private pay collections after insurance cancellation, denial, or other issues, and answer patient questions regarding copays, deductibles, write-offs, and patient responsibility.
- Perform self-pay patient billing.
- Prepare and send patient statements for charges not covered by insurance.
- Perform other duties as assigned.
Requirements & Qualifications
Qualifications
- Knowledge of Medicaid, Medicare, and commercial insurance rules and procedures in a managed care environment.
- Experience with medical terminology, CPT, HCPCS, and ICD-10 coding and modifier usage.
- Understanding of FQHC billing procedures and sliding fee schedules preferred.
- EHR system experience, preferably Intergy or another ambulatory care system.
- Understanding of HIPAA guidelines.
- Proficiency with Microsoft Office Suite, especially Excel.
- Accurate alpha-numeric data entry skills.
- High school diploma or equivalent required; associate degree preferred.
- 2 years of medical billing experience.
- CMRS, CPB, or CPC certification preferred.
- Strong attention to detail, documentation, analytical, and problem-solving skills.
- Ability to multitask in a fast-paced environment.
- Strong written and verbal communication skills.
Location
Florida, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
2 weeks ago
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