Serves as billing and coder to ensure correct codes are used to bill behavioral health and primary care services per government and insurance regulations. Reviews and verifies documentation supports diagnoses, procedures and treatment results.
Analyzes medical billing records and identifies billing and coding deficiencies. Serves as resource and subject matter expert to upper management, billing department and clinical staff. Collaborate with counselors and or physicians on coding matters.
Maintain billing and coding fee schedule updating as necessary and keeping the billing department and clinical staff informed of updates with codes and rates per disciplines.
Will randomly audit/review a percentage of progress notes for coding accuracy and notify clinical staff of coding/billing discrepancies prior to claims submission.
Knowledgeable of coding primary care and outpatient behavioral health records according to CPT-HCPCS and ICD-10 and ICD-11 CM for purpose of reimbursement and compliance with federal regulations according to diagnosis procedure.
Comply with medical and coding guidelines and polices.
Compile billing errors and distribute to the clinic, tracking billing errors to compile on a spreadsheet, checking the clearinghouse for rejections and denials corrections claims as necessary. Resubmit or appeal denied claims. Check clearinghouses and payer sites for EOB's (Explanation of Benefits) and review for denials. Call insurance if needed to get claims paid. Prepare and print HCFA 1500 paper claims for mailing. Prepare write off list and submit for approval. Complete write-offs process.
Maintain a spreadsheet to track credit balances for refunding.
Accounts Receivable- Review and keep Accounts Receivables current and up to date. Call on claims that are going into the over 60 day category to see why they aren't paid yet, especially on the Healthy Plans. Present findings at team meetings. Analyzes claims denial data to also track for technical assistance needs. Research denials to determine the reason, and then notify fee setters and or managers of ways to improve and prevent denials in the future. Follow-up to make sure claims that were denied for varied reasons are fixed (if fixable) and flagged for resubmission in the EHR system.
May serve as a backup biller which includes Reviewing/monitoring billing batches to troubleshoot and inform clinical staff to correct any errors in the billing batches that would prevent claims from processing. Troubleshoot to get clinical errors resolved involving missing or incorrect diagnosis and service type code errors on progress notes. Notify and request fee setters to fix errors regarding incorrect guarantor information. Follow-up to make sure these fixes are done and that claims are flagged for resubmission.
Billing Statements & Office of Debt Recovery (ODR): Run statements monthly. Review statements to make sure QMB clients or others that aren't supposed to get statements do not receive a billing statement. Track accounts to ensure clients receive 3 billing statements prior to sending collection letters. Identify delinquent accounts for non-payment. Prepare 60 and 30 day collection letters for delinquent accounts. Write off accounts to Office of Debt Recovery (ODR) that have received collection letters and been approved. Run Action Code report and reconcile it to the ODR placement file.
Contact Information:
For further information about this vacancy, contact:
Ms. Janesia Raybon, MPA