Remote Medical Billing and Account Receivable Specialist

A dependable, team-oriented Virtual Revenue Cycle Specialist who can work closely with the practice administrator to implement all aspects of revenue cycle (Insurance verification, patient payment collection, coding, billing, and accounts receivable management) needed in a great work environment with opportunities for growth.

Coding, Billing, and A/R Specialist position is responsible for maintaining patient demographic/insurance record integrity; referral/prior-Authorization oversight ;Scheduling oversight; ICD-10 coding/charge creation/claim transmission (electronic and paper); rejection/denials handling and appeals; A/R analysis & Payer-specific follow-up process; and preparation of reports.
This position will handle questions, complaints, or problems from insurance companies and families regarding insurance payments and related concerns.

This is a full time, remote (work from home) position that requires a minimum of 40 hours a week availability. The work schedule is US CST 8:00 AM – 4:00 PM Monday – Friday, and occasional weekends (9:00 AM – 1 PM). The work schedule is subject to change without Upgrade to see actual infoTE: Please DO NOT apply if you do not meet the above requirements. Follow job application instructions below. Job link: Upgrade to see actual info

Duties and Responsibilities
• Conducts patient insurance eligibility/benefit verifications and determine patient financial responsibility if applicable.
• Review coding for accuracy and compliance, enter and electronically file claims filing protocol.
• Stays current regarding coding guidelines and reimbursement reporting requirements.
• Communicate with clinic administrative staff when claims data is inaccurate or additional information is needed for the processing of a claim.
• Responsible for billing/coding of clinic services(outpatient and inpatient) and process claims for Medicare, Medicaid, HMOs, PPOs, and other insurances.
• Maintain minimum production of 45 charge creation in 8 hours work shift
• Audit the services performed that are listed on the clinic superbills and procedure logs to prevent loss of revenue
• Research and correct any claims that are denied, resubmit and follow up until paid or resolved.
• Track, document and reconcile the receipt of payments from posted remittance advice.
• Review EOB and post received from Upgrade to see actual infoitiate follow-up phone calls on accounts with an outstanding balance.
• Monitors the revenue cycle activities and resolves any issues (appeals, aging & collections management. generates patient statements and performs the collection of outstanding insurance or patient balances)
• Evaluates billing processes and procedures and assists management in implementing new strategies for process improvement.
• Ensure accuracy of billing to comply with all ICD-10 and CPT-4 rules and regulations.
• Ensure that created charges contain HCC weighted diagnosis as well as payment justification diagnosis.
• Review and fulfill medical record requests from insurance companies (claims or quality-related) and patients
• Consistently check claim statuses to ensure it reaches the correct payer’s destination
• Consistently follow up on unpaid claims over 30 days and filing appeals when appropriate to obtain maximum reimbursement.
• Collect and exhaust all claims on providers’ behalf, allowing them to continue caring for patients
• Help co-workers and patients wherever needed with excellent customer service skills.
• Always adhere to HIPAA Privacy Rules and company confidentiality policies.
• Data entry of daily charges
• Handle other related duties as required or assigned by the physician and practice administrator

Required skills and experience:
• Must have a Bachelor’s degree from a four-year college or university, but extensive experience will be considered.
• Must have a minimum of 3 years of outpatient (medical office) coding, billing and AR experience
• Must have at least one Active coding certificate from the following list: (CPB, CPC, CPC-P, CCS or MCC). CCA, CPC-A certifications are not acceptable.
• Must be able and willing to learn at a fast pace.
• Must be available during CST business hours.
• Must have experience working with US healthcare primary care provider billing, coding and AR
• Proficiency with electronic health records systems required
• Ability to read, understand and follow oral and written instructions is required
• Knowledge and experience with Medicare/Medicaid, Medicare Advantage, and Commercial Insurance
• Advance understanding of ICD-10, CPT, CPT II, and HCPCS Coding Systems as well as a CMS-1500 claim form
• Must have advanced knowledge of medical billing, payment posting, denial handling, account receivables, and revenue cycle management
• Must have experience working with insurance companies to resolve denied claims
• Must have the ability to communicate with patients and colleagues in a clear, concise, courteous and caring manner
• Must have the ability to establish and maintain effective working relationships with patients, employees, and management.
• Must have demonstrated organization skills including the ability to manage multiple tasks and meet deadlines.
• Must have the ability to handle frequent interruptions that result in having to re-evaluate priorities.
• Must have strong clinical knowledge related to chronic illness diagnosis, treatment, and management
• Must have an excellent understanding of medical terminology, disease process and anatomy, and physiology.
• Must have High Computer proficiency (including MS Windows, MS Office, and the Internet)
• Must have high-speed Internet access, a home computer with a current Windows operating system, MS Internet Explorer (version 6.0.2 or better), and Adobe 6.0 or better;
• Must be task-oriented, reliable and be able to meet designated deadlines and productivity standards (24-hour turnaround time on all assigned charts required).
• Must have strong Personal discipline to work remotely without direct supervision;
• Must have Knowledge of HIPAA, recognizing a commitment to privacy, security, and confidentiality of all medical chart documentation.
• Must have strong organizational skills; interpersonal and customer service skills; excellent English written and oral communication skills; and analytical skills.

APPLICATION INSTRUCTIONS:
Please send a copy or link of your CV / Resume with a description of your abilities to our email at Upgrade to see actual info

Please provide a brief but clear answer to the following questions in your email when applying:
1) What is your highest level of education?
2) What active coding certification do you possess(CPB, CPC, CPC-P, CCS or MCC)? How many years of coding, billing and AR experience do you have?
3) How many years of experience do you have with EHR Systems? Which EHRs have you used?
4) Have you ever worked as a virtual employee? If yes, for how long?
5) Are you currently working? If yes, what are your current work hours?
6) The position is to support outpatient practice located in Central US Standard Time work hours. Are you willing and available to work these hours (this is your midnight to morning)?
7) Do you have a reliable computer and internet connection? What are the configurations and speed test results?