RCM Billing Specialist

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.


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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 review...