Medical Billing & Collections Specialist – ASC, Surgical
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Job Description
Medical billing specialist managing coding, claims, payments, and denials for Advocate Health’s surgical center. Supporting financial performance through accurate billing and collections.
Responsibilities:
- Review medical records for documentation accuracy and assign correct CPT and ICD-10 codes to claims
- Conduct or assign audit reviews of coding and procedure specifications
- Perform and oversee billing processes, including primary/secondary billing and rebilling
- Apply necessary claim edits using internal and external software systems
- Maintain current knowledge of rules and regulations for government payers including Medicare, Medicaid and VA
- Check clearinghouse transmissions daily to ensure files are successfully transmitted
- Work with vendors to resolve workflow-impeding problems or trends
- Follow up on billed patient accounts to collect outstanding balances
- Post payments via cash, credit cards, EFT and third-party vendors
- Review and adjudicate EOBs/RAs to determine whether the Surgery Center was paid correctly
- Handle denials and appeals to obtain claim payment
- Monitor KPIs associated with the Surgery Center's financial performance
Requirements:
- High school diploma required
- An Associate degree, suitable Trade School or Coding Certification preferred
- 2-5 years' experience in a medical environment required, preferably in the surgical realm
- Strong medical terminology knowledge
- Thorough working knowledge of CPT and ICD-10 codes
- Ability to process outgoing claims, write billing edits, transmit transaction files and process payments
- Strong typing skills
- Significant computer, email, copier and Microsoft Office experience required
- EMR experience required, including both clerical and clinical functions
- Knowledge of ASC billing preferred
- Knowledge of billing rules and regulations through various governmental programs required
- Knowledge related to commercial claim submission
- Firm grasp of HIPAA guidelines
- Ability to lift, carry or push/pull up to 20 pounds and occasionally over 20 pounds
- Must live in one of the listed states: AK, AL, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY
Benefits:
- Comprehensive Total Rewards benefits and well-being programs
- Competitive compensation
- Premium pay such as shift and on-call pay
- Incentive pay for select positions
- Opportunity for annual increases based on performance
- Paid Time Off programs
- Medical, dental, vision, life, and Short- and Long-Term Disability benefits
- Flexible Spending Accounts for eligible health care and dependent care expenses
- Adoption assistance
- Paid parental leave
- Defined contribution retirement plans with employer match
- Other financial wellness programs
- Educational Assistance Program
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