Company Overview
Medi-Centrix offers a physician-focused approach to revenue cycle management, data extraction, and decision support. We help physicians navigate the healthcare landscape as it evolves and prepare you for participation in value-based care arrangements and bundled payment models. To ensure that our strategy and deliverables continue to address the most pressing needs of today's physician community, we rely on our Physician Advisory Board to provide valuable insights.
Job Purpose
The Claims Edits Billing Representative is responsible for charge capture and claim submission.
Responsibilities and Duties
Review Physician Office Charge entry to ensure that all charges for each date of service have been captured
Where appropriate, completes charge corrections into billing system based of office documentation
Meets and maintains daily productivity standards established in departmental policies
Meets and maintains quality standards established in departmental policies
Adheres to the policies and procedures established for the client/team
With working knowledge of the insurance follow-up process with understanding of the fundamental concepts in healthcare reimbursement methodologies, verifies and ensures that the patients demographics are properly entered in the host system, corrects when necessary and verifies that proper authorizations are entered
Perform special projects and other duties as needed. Assists with special projects by utilizing excel spreadsheets, and the ability to communicate results.
Basic knowledge of healthcare claims submissions and processing including: ICD-10, CPT, and HCPC codes LCD guidelines, rejections, clearinghouse, as well as 1500 forms
Ability to analyze, identify and resolve issues which may causing payer payment delays
Act cooperatively and courteously with patients, visitors, co-workers, management and clients
Maintain confidentiality at all times
Maintain a professional attitude
Other duties as assigned by the management team
Qualifications
Previous experience in Hospital/Facility or Physician billing : at least 1 year
Experience with EClinical Works or EPIC PB preferred
Advanced knowledge of various types of insurance plans, CPT, ICD-10, billing guidelines.
Strong understanding of professional claim invoicing such CMS 1500 and EDI (Electronic Data Interchange).
Skilled with clearinghouse rejections, demographics, and modifiers.
Understanding how to read an EOB
Ability to work well individually and in a team environment.
Proficiency with MS Office (Excel, Word)
Ability to work well individually and in a team environment.
Proficiency with MS Office
Strong communication skills/oral and written
Strong organizational skills
Working Conditions
General office environment
While performing the duties of this job, the employee is occasionally required to move around the work area
Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear
The employee must be able to follow directions, to get along with others, and handle stress
The noise level in the work environment is usually minimal
Medi-Centrix provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Medi-Centrix complies with applicable state and local laws governing nondiscrimination in employment in every location where the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
