Procedural Billing Specialist I

Pay Range :$20-$22hr Shift Timings: 9am-5pm M-F Job Summary: -Performs specialized coding services for inpatient and outpatient medical office visits. Reviews physician coding and provides updates. -Provides comprehensive financial counseling to patients. Responsible for setting patient expectations, discussion of financial options, payment plans, one-time settlements and resolution of unpaid balances. -Discusses with patients the details concerning their insurance coverage and financial implications of out-of-network benefits, including pre-determination of benefits, appeals andor pre-certification limitations. -Develop and manages fee schedules and for self-pay patients. -Processes Worker's Compensation claims and addressesresolves all discrepancies. -Conducts specialized negotiations with insurance companies. Brokers and negotiates with insurance carriers. Establishes a network of key representatives within the insurance pre-certification units to establish open lines of communication for future service negotiation. -Verifies insurance and registration data for scheduled office, outpatient, and inpatient procedures. Reviews encounter forms for accuracy. Responsible for obtaining pre-certifications for scheduled admissions. -Enters office, inpatient, andor outpatient charges with accurate data entry of codes. -Posts all payments in IDX. Runs and works missing charges, edits, denials list and processes appeals. Posts denials in IDX on a timely basis. -Provides comprehensive denial management to facilitate cash flow. Tracks, quantifies and reports on denied claims. -Directs and assists with responses to problems or questions regarding benefit eligibility and reimbursement procedures. -Researches unidentified or misdirected payments. -Works credit balance report to ensure adherence to government regulationsguidelines. -Analyzes claims system reports to ensure underpayments are correctly identified and collected from key carriers. Reviews and resolves billing issues and provides recommendations. -Identifies and resolves credentialing issues for department physicians. -Maintains a thorough understanding of medical terminology through participation in continuing education programs to effectively apply ICD-10-CMPCS, CPT and HCPCS coding guidelines to inpatient and outpatient diagnoses and procedures. -Meets with practice management, leadership andor physicians on a scheduled basis to review Accounts Receivable and current billing concerns. -Mentors less experienced billing staff and assists Billing ManagerRevenue Cycle Manager in staff training. -Other identified duties as assigned. Required Skills & Experience: -Urology coding experience -Excellent organizational skills. -Excellent communication and customer service skills. -Knowledge of medical terminology and anatomy. -Strong attention to detail and ability to multitask. -Excellent calculation, verbal and communication skills. -Strong ability in analysis and research. Education: Associate's degree preferred.

Created: 2025-03-03