1) Billing/Coding Specialist

• Focus on proper ICD-10, CPT, and HCPCS coding

• Review medical record documentation to validate & ensure proper charge capture

• Report insufficient documentation issues

• Report over-coding/undercoding issues

• Work with Reimbursement Specialists & Account Managers to ensure minimum claim denials

2) Reimbursement Specialist

• Focus on payment posting, denials management, unpaid claims

• Reconcile/record batch payments from insurance payers

• Responsible for managing 1°, 2°, 3° claims ageing reports

• Communicate directly with insurance payers to resolve claims issue

• Create & file appeals as necessary

• Effectively communicate coding/billing issues which are causing denials to both account managers & billing specialist

3) Account Manager

• Responsible for coordination and quality assurance of all aspects of customer’s revenue cycle

• Provides customer service- main point of contact

• Understands & communicates coding/billing/compliance regulations

• Manages patient invoicing and collections

• Works with other 2 reps to maximize overall account efficiency

You will also work closely with a credentialing specialist during the implementation phase of service.

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