Certified Professional Coder CPC/Insurance Accounts Receivable Representative (Full-time)

Company: WC Health
Location: Las Vegas
Posted on: May 25, 2023

Job Description:

Company Name: WC HealthJob Title: Certified Professional Coder CPC/Insurance Accounts Receivable RepresentativeCompany Introduction:In every convenient location, WC Health provides patients with comprehensive and integrated health care focused on behavioral health.As we continue to evolve as a company, we are proud to have stayed true to our original mission of creating services and products that make a positive difference in people's lives. We pledge to continue to challenge the status quo in healthcare delivery and strive to develop new programs through the collaborative efforts of our dedicated team, partners, patients, and communities we serve.Our wrap-around services include medical, housing, pharmacy, transportation, case management and mental health services.Voted as one of the top 5000 growing healthcare companies by INC 5000, we are looking for highly motivated individuals to join our growing team.To learn more about our company, please visit our website at Objective:The Insurance Accounts Receivable Representative's primary responsibility is to provide the highest quality of customer service and accounts receivable management to our patients by embracing the Well Care Guiding Principles. The representative will review and analyze patients' medical records in conjunction with the accounts receivables to ensure that the claims were billed correctly, and that the insurance company has the necessary information to adjudicate the claims. The representative must be well versed with the insurances and adjudication processes of their partner practices. The representative will follow the prescribed steps in the Insurance Follow-Up Process to ensure that the outstanding A/R is collected within 120 days from the aging date. The representative will accept other duties/projects as assigned by the Revenue Cycle Manager. Must be knowledgeable of HIPAA Law, and standard coding such as CPT/HCPCS.Certified Professional Coder CPC primary role of the Specialist is to abstract and identify the correct CPT and ICD-10 codes from various encounter forms and medical reports and file claims to insurance for timely and accurate reimbursement. The Specialist, Medical Coding and Billing is responsible for assisting other staff with CPT and ICD-10 coding issues hindering expedient collection processes. Responsibilities include confirming modifier coding, utilizing sound professional coding judgment in establishing priority sequencing of diagnosis codes and services to assure maximum allowable reimbursement consistent with Insurance Carriers.Essential Functions:The Insurance Accounts Receivable Representative's Role and Responsibilities:Prepare and edit medical claims for submission, both hardcopy and electronically, to various third party payors and clearing houses.Follow-up and collect outstanding aged trial balance reports, including but limited to oral and written communications. Analyzes and appeals difficult to collect accounts.Review and process the daily correspondence to correct or update inquiries from insurance carriers.Special projects as assignedMedical Coding and Billing Responsibilities:Assigns appropriate codes for a 95% accuracy rate or better (quality standard).Reviews chart documentation to support ICD-10 and CPT codes, and takes appropriate action if documentation is not supported by coding appropriately.Analyzes and evaluates findings, diagnosis and procedure codes identified by clinicians.Researches CPT and ICD-10 coding discrepancies for compliance and reimbursementaccuracy and timeliness.Utilizes Internet and other resources to research newly identified diagnosis and/or other procedures.Answers inquiries from staff and/or clients concerning CPT and ICD-10 codes.Maintains updated knowledge of coding requirements; including continuing education and certification renewal.Maintains accurate and up to date logs of discrepancies in coding trends and root cause analyses that negatively impact collections and presents this information and innovative resolutions to the Senior/Billing Manager.Other duties as assigned.Knowledge, Skills and Abilities:Type at least 45 WPMComputer skills required (Word, Excel, PowerPoint) basic computer knowledgeIntermediate oral and written communication skills requiredStrong Organizational skillsExcellent Analytical skillsExcellent Time management skillsPositive and Professional attitude is expected to be maintained at all timesPosition Type: Full-timeEducation and Experience:Certified Professional Coder CPCHigh School Diploma or equivalent3-5 years billing experience in a high-volume multi-specialty setting, Medicare and or Medicaid billing experience preferred.

Keywords: WC Health, Las Vegas , Certified Professional Coder CPC/Insurance Accounts Receivable Representative (Full-time), Other , Las Vegas, Nevada