SUMMARY: This position is responsible for providing overall support in the Business Office for the Digestive Disease Endoscopy Center (DDEC) and Ambulatory Surgery Center. This includes, but is not limited to operative coding, preparing and submission of charges both professional and facility to insurance companies and patients, posting insurance payments to the practice management system, and interacting with insurance companies and patients about billing status and questions.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following: (Other duties may be assigned.)
- Coding all procedures (including pathology)
- Reads, interprets, and understands operative notes and other medical reports
- Assigns the appropriate CPT code for each case
- Queries physicians as needed
- Understands bundling and modifiers and adheres to government regulations
- Assigns diagnosis codes appropriately and to the highest level of specificity
- Charge Posting
- Apply charges to patient accounts accurately and in a timely manner for both professional and facility services
- Apply time of service patient payments to patient accounts accurately and in a timely manner for both professional and facility
- Encounter tracking for all appointments to be sure each scheduled appointment has an appropriate charge associated with it
- Claims Processing
- Process electronic bill submission/remits
- Receipt Entry
- Responsible for maintaining and understanding the accounts receivable status of all billing accounts for DDEC
- Post third party payer and patient payments
- Work credit balances
- Transfer balances to self-pay or secondary insurance
- Initiate appeals for underpayments or denials
- Place appropriate notes in patient account
- Insurance Analyst
- Ensures accurate payment from the insurance company
- Work AR and investigate rejections on EOB
- Submit appeals and corrected claims and follow the account to completion
- Call insurance companies to determine status on all accounts over 30 days
- Post corrected claims and any payments associated with that correction
- Send supporting documentation required by insurance companies
- Note contact with insurance companies in the patient account, and mark account for follow up, until resolved
- Complete insurance refund request form with supporting documentation
- Patient Accounts
- Process patient statements and collection letters
- Contact patients to discuss delinquent account
- Set up reasonable payment plans
- Prepare account for Collection Agency
- Accept patient or insurance company telephone inquiries and assist by providing excellent customer service
- Assist with DDEC Front Desk coverage as needed
- Notify manager of trends, medical policy updates, etc.
- Communicate with other Departments, as needed
- Communicate with physician and/or clinical staff to resolve issues in a timely manner
- Must have predictable and consistent attendance
- Knowledge of insurance plans accepted by DDEC
- Follow company guidelines in applying self-pay discounts, charity, and per request adjustments
- Adhere to end of month requirements
SUPERVISORY RESPONSIBILITIES:
- This position has no supervisory responsibilities.
