Billing & Coding Specialist
About this role
39 Paid Days Off Each Year
Position Summary
This position focuses on all elements of revenue cycle processes from claim creation to follow-up on denials including handling and adjusting patients’ accounts per EOB response. Additionally, the position requires taking care of any patient queries in regard to statements, fulfilling itemized bills for law firms and processing patients and insurance refunds.
Duties and Responsibilities
- Process missing slips in Athena and create claims according to payer’s requirements and guidelines.
- Follow up on all denied claims and drive it to proper resolution.
- Process inpatient charges in Alert MD.
- Process chronic care coordination charges in Time Doc.
- Identify claims that need referrals or additional information for payment.
- Manually post dental payments in Dentrix.
- Process, follow up on and resolve requests for itemized bills.
- Manage and follow up on payment plans offered to patients with outstanding balances.
- Review and analyze account balances to determine true insurance and patients’ refunds.
- Follow up with patients when updated insurance information is needed to process claims.
- Maintain regular communications with patients until such time that accounts are paid in full.
- Attend all departments’ meetings as well as PrimeCare all-staff meetings.
- Coordinate and submit settlement offer for approval.
- Other duties as assigned.
Required Skills or Abilities
- Work effectively with a diverse group of professionals within the whole organization.
- Exercise independent judgment and prioritize effectively.
- Analyze, recommend, and implement creative improvements.
- Demonstrate ability to work independently and in a team-based environment.
- Strong interpersonal skills demonstrating ability to establish strong working relationships and communicate effectively in a confidential manner.
- Maintain appropriate professional boundaries with all staff, trainees, and patients at all times.
- Demonstrate respect and sensitivity for cultural diversity, gender differences, and sexual orientation of patients and co-workers.
- Strong knowledge of ICD-10, CPT-4 and HCPCS coding as well as basic medical terminology
- Ability to interpret and analyze EOBs (explanation of benefits).
- Proficient skills/experience with Microsoft Office products (Outlook, Word, Excel, PowerPoint) and Adobe.
Required Knowledge, Experience, or Licensure/Registration
- Bachelor’s degree in business administration, accounting, or finance preferred.
- CPC or CPC-A certifications strongly preferred.
- 3 – 5 years of experience in outpatient/inpatient Medicaid, Medicaid MCOs, Medicare, Medicare Replacement, and commercial insurance billing preferred.
- Prior experience in health care organizations and experience in FQHC strongly preferred.
- Prior experience with Athena EMR strongly preferred.
Benefits
- 27 days of PTO each year, accrued each pay period
- 3 personal days
- 1 floating holiday
- 8 paid holidays
- Medical/Dental/Vision coverage available the 1st of the month following 30 days
- Company-paid life, short-term disability, and long-term disability coverage
- Discretionary 403(b) match and profit sharing after meeting service requirements
- Flexible spending accounts
- Accident & critical illness coverage
- Pet insurance
Salary
All wages are based on relevant years of experience. The minimum rate is the wage a candidate with no additional experience will earn.
PrimeCare Health is firmly committed to creating a diverse workplace and is proud to provide equal employment opportunities to all applicants. Therefore, PrimeCare does not discriminate on the basis of creed, color, national origin, sex, gender identity, sexual orientation, age, religion, marital or parental status, alienage, disability, political affiliation or belief, military or military discharge status.
Company at a glance
PrimeCareHealth (PrimeCare) is a federally qualified community health center (FQHC) that provides quality, affordable care to medically underserved populations on Chicago’s West and Northwest sides. Over its 22-year history, PrimeCareHealth has built a community-inspired, nationally recognized health care system that provides comprehensive family medical care at its five accessible locations, including health services for adults, seniors, women and children, as well as prenatal health services, behavioral health counseling, and case management, regardless of patients’ ability to pay.
Our clinics and health centers are staffed with trained medical professionals, including physicians, residents, nurses, case managers, care coordinators and service support staff. Our Behavioral Health services are fully integrated into our health care. Our licensed clinical psychologist and several licensed counselors work closely with our medical providers to support patients dealing with chronic conditions and diagnosed mental health issues.
Included in our approach
- Family Medicine-model of care for patients of all ages, from newborns to seniors
- Strong Emphasis on prenatal care and complex chronic disease care, including case management and care coordination
- Seamless provider transition between care settings – primary care, specialty care, acute inpatient, rehabilitation and long-term settings.
- Behavioral health services for children and adults integrated into primary care
- Outreach and Enrollment services for Medicaid expansion and Marketplace clients
- Culturally and linguistically competent care, with emphasis on underserved Latino and Polish communities – more than 65% of patients are served in a language other than English.
Top Benefits
- Paid time off
- Personal days
- Floating holiday
- Paid holidays
- Medical coverage
- Dental coverage
- Vision coverage
- Life insurance
- Short-term disability
- Long-term disability
- 403(b) match
- Profit sharing
- Flexible spending accounts
- Accident insurance
- Critical illness coverage
- Pet insurance
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