RCM Billing Specialist (Administrative)
Key Responsibilities Will Be:
Accurate Claim Filing
- Prepare, review, and submit claims to insurance companies accurately and within specified timelines, ensuring that all claims meet payer requirements.
- Ensure that claims are complete, with all necessary documentation and coding included to prevent rejections or denials.
- Monitor claims for accuracy, resolving discrepancies, and conducting follow-ups on outstanding claims to facilitate timely payment.
Coding and Documentation Compliance
- Apply accurate ICD-10, CPT, and HCPCS coding in compliance with payer and regulatory guidelines, ensuring that services are appropriately coded for optimal reimbursement.
- Work with clinical and administrative teams to clarify and obtain necessary documentation or coding details, ensuring claims are coded accurately.
- Keep up-to-date with current coding practices, payer guidelines, and regulatory requirements to maintain compliance and accuracy in claim submissions.
Claims Submission and Follow-Up
- Verify patient insurance coverage and eligibility prior to claim submission, ensuring that payer requirements are met to avoid rejections.
- Submit claims electronically or via paper as required by payers, confirming that claims are processed efficiently within the revenue cycle.
- Conduct follow-up on submitted claims, contacting payers when necessary to resolve any issues or delays, and taking corrective action on denied or rejected claims.
Billing and RCM Compliance
- Maintain strict adherence to HIPAA and all applicable billing and coding regulations to ensure patient privacy and compliance.
- Assist with periodic audits of billing and coding practices to ensure compliance with payer and regulatory guidelines.
- Stay informed about industry updates, payer requirements, and changes in billing codes to ensure that claim submissions reflect current standards.
Qualifications:
- Education: High school diploma or GED required; an Associate's degree or certification in medical billing, coding, or a related field is preferred.
Experience:
- 1-3 years of experience in medical billing, coding, or claims processing.
- Knowledge of ICD-10, CPT, and HCPCS coding, as well as familiarity with EHR/EMR and billing software.
- Certifications: CPC (Certified Professional Coder), CBCS (Certified Billing and Coding Specialist), or similar certification preferred but not required.
Skills:
- Strong understanding of medical terminology, billing procedures, and coding practices.
- Excellent attention to detail with the ability to accurately file claims and identify discrepancies.
- Strong communication skills, with the ability to work effectively with team members, clients, and external payers.
- Proficiency with Microsoft Office (Word, Excel) and billing software systems.
Competencies:
- Attention to Detail: High level of accuracy and thoroughness in reviewing, coding, and submitting claims, ensuring adherence to payer guidelines.
- Problem Solving: Ability to identify and resolve billing discrepancies or coding issues, working proactively to prevent claim rejections.
- Compliance-Oriented: Committed to maintaining strict confidentiality and compliance with HIPAA, payer guidelines, and regulatory requirements.
- Organizational Skills: Effective time management and organizational skills to handle multiple claims, follow-ups, and ensure timely submission.
- Communication: Skilled in clear and professional communication with internal teams, clients, and payers to resolve issues and clarify documentation.
