Our client - a healthcare facility in Trenton, is seeking a Dental Biller/Coder. This is a temp-to-hire position. Under the supervision of Finance Revenue Cycle Manager, this position is accountable for quality, productivity, cost effectiveness and timeliness of work to ensure efficient and effective billing of all third-party payers, including the proper utilization of external vendor data conversion services, where needed. Performs related work including, but not limited to:
• Work closely with Revenue Cycle Management Support Services Provider located overseas in reference to medical coding and reviewing claims processed
• Management of Medicaid Wrap, LOA, and Medicare wrap submissions to different agencies for reimbursement
• Provides technical assistance and training to providers and patient representatives/call center staff, as needed.
• Responsible to work with Quality Assurance department to establish and track quality indicators.
• Suggests and designs workflow improvements to enhance and strengthen the revenue cycle.
• Maintains current knowledge of billing practices, procedure codes, and patient insurances. Coordinates ICD-10 and CPT coding with the appropriate providers.
• Facilities and coordinates with Patient Representative/Call Center Supervisor feedback on errors to ensure registration/insurance information are properly documented.
• Provides superior customer service to all patients and takes a solutions-oriented approach to all complaints related to patient billing issues.
• Coordinates ICD-9 and CPT coding with the appropriate Provider.
• Identifies problems that impede progress to complete data input or billing process and recommends solutions.
• Use the Federal Poverty Guidelines to create and manage sliding fee scales in Athena and Dentrix
• Assure compliance with HRSA Billing and collection requirements
• Supervise and monitor Medical-Dental Coder/Biller in missing slips and daily duties
• Responsible for reviewing, recording, reporting, and monitoring LOA process, Medicaid Wrap and PPA submission process in coordination with outsourced Billing Company
• Submission of Quarterly Medicare credit balance report
• Responsible for Athena Payer enrollment tables set up, responding, and completing Athena enrollment tasks
• Liaison between Insurance company representatives and HJA, working to resolve payment and credentialing issues with close coordination with credentialing department
• Responsible for resolution of "Client Assistance Requested" report from outsourced billing company and taking necessary actions to complete
• Responsible for case policy claims for follow up and close out, upload Medicaid remits and capitation reports
• Prepare Standard Operating Procedures and Policies when needed
• Conduct follow-up with insurance companies on unpaid claims, if required or necessary.
• Works closely with all front desk staff to provide feedback on errors to ensure insurance information is being entered properly.
• Work closely with Senior Management to determine and expedite claim statuses.
• Handle medical inquiries and questions related to Medical Coding via telephone or directly in a personal and professional manner. Strong medical and dental coding recommended
• Willingness for multi-tasking and have flexible work approach
Performs any additional duties assigned by the Finance Revenue Cycle Manager.
EDUCATION & EXPERIENCE:
• High School Diploma required, Bachelor's degree preferred, or some college combined with equivalent experience.
• One (1) - Two (2) years' experience in work involving medical coding, submission of claims, review and working on denials with Payers.
KNOWLEDGE, SKILLS, ABILITIES AND OTHER (KSAO's)
• Ability to work independently and to carry out assignments to completion with minimum instructions, adhere to prescribed routines and practices, maintain records, and to make reports requiring accuracy.
• Computer literacy including proficiency in Microsoft Word and Excel
• CPC certification and familiarity of FQHC medical billing and coding will be preferred
• Skill in the application of modern office techniques and practices and the use and care of office machines and equipment. Working knowledge of MS Word, MS Excel for Windows, and willingness to learn various software packages.
• Experience with Athena (Medical Billing) and Dentrix (Dental Billing) Software a plus but not required.