Detroit, Michigan
Medical Billing and Coding Specialist Job Opening in Detroit, Michigan - Certified medical billing/coder specialist Job duties:
Researches any error claims and makes necessary corrections for clean claim production and submission on an as needed basis;
Researches claim rejections, making corrections, taking corrective actions and/or referring claims to appropriate staff members for follow through to ensure timely claim resolutions;
Proactively follows-up on delayed payments by contacting patients and 3rd party payers, and supplying additional data, as required;
Reviewing remittance advice forms to verify proper reimbursement to make adjustments as necessary;
May perform financial counseling activities, including but not limited to:
Seeks appropriate funding based upon patient requirements, collecting supporting documentation (payroll stubs, tax returns, credit history, etc.), as required. Provides information and education to the patient, family member and/or guarantor of the process. In so doing, the incumbent will encourage patient participation in the funding process and will assist the patient in forwarding the required documentation and application to the appropriate funding agency:
Counsels patient/guarantor on patient?s financial liability, third party payer requirements and outside financial resources, including private organizations and foundations, eligibility vendor(s), Medicaid, Medicare, Champus, and/or federal disability programs, etc.;
Counsels patient/guarantor of payment plan options and establishes appropriate plan;
Investigates No Fault and Workers? Compensation cases, retrieving police report and insurance information, as required;
Assists patient/guarantor in completing a charity application, financial statement and/or payment contract when required according to hospital policies. Analyzes such applications along with income/resident documentation in order to advise the patient of available options. Initiates requests for charity write-off, when appropriate;
Analyzes financial and eligibility data, and length of disability to determine potential eligibility for federal, state, and/or county programs, completing the necessary documents within the time limits specified by the appropriate government agency;
Determines and manages proper course of action for optimal reimbursement of healthcare charges (e.g., spend down eligibility, out-of-network, Cobra coverage, etc.); and
Informs patient/guarantor of flat-rate and discount programs and assists patient in application process, ensuring that adjustments are requested and completed. (Financial Counselor responsible)
Evaluates accounts, resubmits claims, and performs refunds, adjustments, write-offs and/or balance reversals, if charges were improperly billed or if payments were incorrect; and
Updates and rebills claim forms in a timely, accurate manner.
Determining the correct codes for patient records
Using codes to bill insurance providers
Interacting with physicians and assistants to ensure accuracy
Keeping track of patient data over multiple visits
Managing detailed, specifically-coded information
Job Type: Full-time
Required license or certification:
Billing and Coding Certification
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