Description:
Key Responsibilities
Medical Billing & Revenue Cycle Management
- Manage full-cycle medical billing, including claim creation, submission, payment posting, and denial management.
- Process and organize patient accession records, ensuring 100% accuracy in charge capture and data categorization prior to claim submission.
- Follow up aggressively on aging A/R and draft appeals for denied claims to maximize revenue recovery.
- Verify patient insurance eligibility, benefits, and pre-authorizations as necessary.
- Generate detailed financial reports and utilize spreadsheet processing tools to track practice revenue metrics.
Practice Auditing & Onboarding
- Conduct baseline and routine internal audits of billing practices, coding accuracy (ICD-10, CPT, HCPCS), and general workflow compliance.
- Prepare detailed practice audit agreements and compliance reports for physician review.
- Assist in the onboarding of new practices, establishing secure billing workflows and standard operating procedures.
- Identify systemic coding errors or operational bottlenecks and implement corrective action plans.
- Ensure all billing activities adhere strictly to state, federal, and payer-specific guidelines (including HIPAA/OIG compliance).
Qualifications & Skills
- Experience: 5+ years of progressive experience in medical billing, revenue cycle management, and coding.
- Auditing Expertise: Proven track record of conducting medical practice audits and implementing revenue-optimizing workflows.
- Certifications: Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), or Certified Medical Reimbursement Specialist (CMRS) strongly preferred.
- Technical Proficiency: Advanced proficiency with EMR/EHR systems, clearinghouses, and spreadsheet management (Excel) for deep-dive data analysis.
- Soft Skills: Exceptional attention to detail, highly organized, and capable of communicating complex audit findings clearly to medical providers and administrative staff.