Medical Billing/Coding/Collections

DESCRIPTION

PFS Billing Specialist

Essential Functions:
Analyzes, investigates and resolves account issues, including resubmitting and updating lien and claim document information.
Accesses available resources, such as the Membership System, Resolute, Diamond payer databases to locate missing or incorrect information. Updates medical claims with corrected billing information and releases claims for transmission to the payer.
Investigates and documents actions taken to resolve medical billing discrepancies and unusual charges and credits.
Performs follow-up collection activity/negotiation of lien settlement via pre-assigned work queues to expedite payments.
Works high priority TPL/MVA/WC cases according to department policies and procedures.
Conducts research to make the determination of related (NON-Plan Services) paid claims for subrogation cases, which includes identification and validation of Third Party Liability/MVA/WC claims cost avoidance opportunities.
Receives and responses to incoming correspondence and calls pertaining to TPL/MVA/WC verification, billing and collections inquires from various sources.
Ensure that all appropriate patient service charges are entered into the billing system.
Provides feedback to Financial Coders regarding coding and billing edits.
Performs other duties as directed.

Required Experience:
8 years of medical billing/coding/collection experience to include knowledge of CPT, ICD-9, HCPCS codes;
.*with an Associates Degree ONLY 6 years is required; with a BA/BS degree ONLY 4 years is required.*
Experience with Third Party Liability/Attorney and Worker Compensation collections.
Experience with/knowledge of Worker's Compensation and Third-Party Liability/MVA billing and collection; procedures and regulations.
Knowledge of compliance medical and insurance terminology
Familiarity with CMS 1500 and/or Electronic Billing

Preferred Experience:
Knowledge of Microsoft Word, Excel, and Access
Experience with/knowledge of Lotus Notes, Resolute, Diamond, and TPL Module

Required Education:
High School Diploma or equivalent.

Skills to be successful in this role:
Customer Service
Ability to resolve conflict
Issue resolution and management
Ability to integrate
Effective communicator
Adaptable