Medical Billing Specialist - Women's & Children Business Services (Full Time - Days) Job Listing at Sutter Medical Foundation - Central in Sacramento, CA (Job ID SMF-C-1214590)
The Medical Billing Specialist supports the Front Office Support management team at a regional level by monitoring the various charge activities and billing reports and by acting as the first line support to the care center staff and clinicians. Responsible for supporting the professional fee billings by auditing charge postings routinely and identifying areas for billing improvements and controlling billing rejections. Accountable for performing prospective audits on all level 5 services for their particular region(s) of responsibility. Also will assist in identifying and accurately resolving billing, coding, and compliance issues in a timely matter for their assigned region(s) and take responsibility for working appropriate TES edits and weekly rejection/IIS reports.
MINIMUM POSITION REQUIREMENTS
High School Diploma or equivalent
College course work preferred
Certification in physician coding by American Health Information Management Association (AHIMA – CCS-P) or American Academy of Professional Coders (AAPC – CPC). Students currently enrolled in a coding program and eligible to test for certification can be hired with understanding that certification is to be obtained within year of hire date.
Minimum of 3 years medical group billing/registration experience preferred.
Professional experience sufficient to recognize and make appropriate judgment regarding care center billing operational issues.
Knowledge of front desk accountabilities and procedures
Knowledge of TES Edit System/Rejection Reports/IIS Reports
Knowledge of Missing Charge Reports and resolution workflows
Knowledge of current ICD-9, CPT and HCPCS coding.
Knowledge of E/M auditing and the 1995/1997 documentation guidelines.
Knowledge and understanding of all insurance plans, including government, PPO and capitated plans. Computer billing, problem solving, and accounts receivable proficiency. Knowledge of medical terminology. Must maintain currency with HCFA regulatory guidelines, insurance billing requirements, state and federal laws and regulations governing capitated, contractual and administrative write-offs, third party liabilities and bad debt.
Ability to function independently, identify problems and implement resolutions with minimal direction and guidance.
Customer service skills sufficient to interface effectively with managers, clinicians, staff members and patients.
Organizational skills sufficient to keep records and recognize inefficient work processes.
Requires ability to learn all Care Center related computer functions and billing practices.
Understanding of internal audit principles sufficient to support regional care centers.
Communicate with physicians effectively regarding documentation requirements, billing errors and solutions.
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