Billing Specialist for Carondelet Case Resolution Team

Description

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Essential Job Responsibilities: 

1. Resolve cases for assigned markets, becoming a subject matter expert on issues unique to the payers in the market.      Mentor and provide constructive feedback to call center agents in ways to more effectively handle situations that led to the case in the future. 
2. Compile examples of emerging issues from denials, staff actions, or patient dissatisfaction.
3. Participate in billing meetings at the market and national level as needed.
4. Review and respond to billing questions from call center staff on a timely basis and follow up as needed.
5. Research payer and MAC websites for claim status or denial information, proactively educating fellow case resolver staff or call center staff.
6. Review claims for accuracy.
   1. Assess possibility of CPT, modifier, or diagnosis issues per payer and refer case to through coding review process when required.
   2. Explain to agent or patient what was discussed during visit using available resources
7. Review held cases for resolution.
   1. Review any coding corrections, adjustments, or credentialing issues during monthly meeting and escalate held cases over 10 days or sooner as needed.

Qualifications

 

Education: High school diploma or equivalent is required. 

 

Experience:  3+ years of experience with physician office billing in a corporation or large multi-specialty physician group practice.

 

Working knowledge of CPT-4, HCPCS, ICD-10, and third party payer rules is required. Understanding of payer explanation of benefits forms.

 

Experience in problem-solving.  Exercising initiative, judgment, and discretion a must. 

Must have excellent written, verbal and interpersonal skills as well as the ability to present information and communicate effectively to a wide variety of people within the organization as well as payer representatives outside the organization.

 

Detail oriented with the ability to identify and research payer documentation and claims to identify areas for process improvement.

 

Ability to organize data and present findings using Microsoft Excel and/or PowerPoint.

 

Work in a fast paced environment sitting for long periods of time.