Medical Billing Specialist 2

The Medical Billing Specialist II codes patient records, ensures accuracy and compliance for healthcare professional Workers' Comp claims. Maintain databases and audit patient charts and billing information for accurate processing of claims. Analyze, identify, and resolve billing issues that cause payment delays. Research and resolve patient, provider, and insurance company inquiries in a timely manner.

Essential Duties and Responsibilities

• Reviewing charts and identifying procedures: abstracting and coding patients' charts, utilizing ICDlO, CPT and HCPCS codes classifications with accordance to California Official Medical Fee Schedule.

• Maintains communication with supervisor regarding significant issues or patterns observed regarding denials from insurance companies.

• Communicate with Physicians to ensure documentation is substantiating services perform and it is accompanying with proper dictation.

• Comply with all California Official Medical Fee Schedule Guidelines.

• Re billing any corrected denials and rejections

• Obtains claim numbers and adjuster contact information promptly and updates medical records.

• Accurately routes bills to either the employer or WC carrier.

• Communicates effectively with carriers and adjusters to submit necessary documentation for payment of claim.

• Review physician's documentation and perform audits to determine accuracy and gaps.

• Responsible for documenting all correspondence with insurance, client, and / or insurance to record.

• Comply with all applicable HIPAA policies and procedures.

• Prepares and sends CMSlS00 and Medical Record to insurance.

• Verify completeness and accuracy of all chart documents and orders prior to submission.

• Follow-up with Physicians to assure completion of all chart documents in a timely manner.

• Collaborate with other departments to obtain and analyze additional information about patients to be able to record and process billing effectively.

• Assists with assigned projects that pertain to billing under the direction of the Billing and Collections Manger.

• ExceIlent customer service skills.

• Problem-solving skills.

• Detail oriented and thorough.

• Strong written and verbal communication skills.

• Ability to collaborate with all levels within the organization.

• Ethical conduct.

• Ability to deal professionally, courteously, and efficiently with internal and external customers.

• Ability to work various shifts and overtime if needed.

• Knowledge of all confidentiality requirements regarding patients and strict maintenance of proper confidentiality on all such information.

• Knowledge of medical terminology, spelling, and office ethics.

Experience

• Minimum of 5 years' experience in coding/billing or in workers compensation bill review.

• Must have experience in billing with claim follow ups, checking the status for unpaid claims, submitting corrected claims, and filing appeals.

• Expert knowledge of ICD-lO and CPT codes.

• Knowledge of Medical terminology.

• Experience in Worker's Comp.

• Knowledge of basic office equipment such as scanners, electronic faxing, iPad, copy machines, etc.

NOTE: This job description may not include all the duties assigned to the employee and may be updated and modified by the department supervisor, according to the operations at any given time.

The base salary is determined on the candidate's education, qualifications, and experience, and is subject to change based on various internal and external factors.

Akeso is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.