Job Description

of Responsibilities: The person in this role may act in either all, one, or some of the following functionalities: Coding, Posting, Claim Resolution, or Benefits Coordination. All functions perform highly technical and specialized functions for the patient financial services department. Persons in this role may be responsible for assisting in new hire training. The person in this role must maintain patient confidentiality and adhere to all policies and procedures as outlined in Employee Handbook or departmental guidelines. Must adhere to work schedule as well as time and attendance policies - variable work schedules 7:00 am until 6:30 pm Monday through Friday. These hours can/ may change based upon department needs. Duties and responsibilities may be added, deleted or changed at any time at the discretion of management, formally or informally, either verbally or in writing.

Coding:

• Reviews, analyzes, and codes diagnostic and procedural information that determines Medicare, Medicaid and private insurance payments
• Perform ICD-10-CM, CPT and HCPCS coding for reimbursement
• Ensures compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines.
• Assigns and sequences ICD-10-CM/CPT/HCPCS codes to diagnoses and procedures for documented information. Assures the final diagnoses and operative procedures as stated by the physician are valid and complete. .
• Abstracts all necessary information and assigns codes (ICD-10, CPT & HCPCS), which most accurately describe each documented diagnosis, surgical procedure and special therapy or procedure according to established guidelines.
• Determines the final diagnoses and procedures stated by the physician or other health care providers are valid and complete. Promotes positive customer relations for the Marietta Eye Clinic.
• Edits (claim scrubbing)
• Charge entry, assignment of ICD-10 code (reasonability, validity)
• Electronic claim submission and rejection follow up
• Co-managed Surgery coordination and reporting

Posting:

• Independently evaluate explanation of payments for patient accounts and understand correspondence based on knowledge of policy and personal discretion.
• Accurately post or record information regarding collection receipts.
• Processes and files information regarding collection receipts.
• Quick evaluation and detail oriented.
• Research oriented and capable.
• Files correspondence, records, and reports.
• Bank and Bank Partner liaison
• Bank Deposit reporting and balancing
• 835 file management, deposit tracking
• Timely application of payments and denials
• Co-managed Surgery coordination and reporting

Claims Resolution:

• Reviews reports (aged trial balance, aging reports, etc.) to ensure timely follow-up and resolution of accounts for assigned payors.
• On a daily basis, researches and corrects denials received for assigned clients.
• Documents all correspondence with patients, insurance carriers and clients.
• Receives payments from patients via phone or in-person.
• Responds to requests for information from patients, insurance carriers and clients within 2 business days
• The claims resolution function/position is responsible for following-up and resolving all unpaid insurance claims for assigned payors.

Benefits Coordination:

• Working Clearwave system to accurately display correct insurance for claim filing
• To ensure all services for MEC have appropriate insurance benefit coverage as well as authorization and notification in place prior to all outpatient electivenon-elective scheduled services and within contractual guidelines for urgent and emergent services.
• Responsible for completing work lists timely.

General Minimum Education and Background Requirements - specifics by function listed below:

• High school diploma or GED.
• Healthcare Experience preferred

Coding CCS, CCS-P or CPC certified or certification in process, 4+ years Ophthalmology experience

Posting: College Degree or High School Diploma, 4+ years Ophthalmology experience, Experience with managed care contracts, Payment posting experience is preferred

Claims Resolution CPC certified or certification in process, Medical Practice experience 2+ years

Benefit Coordination Minimum of one year experience in a hospital admitting/registration practices insurance and managed care areas