Investigates claim denials, performs root cause analysis, and responds to inquiries about documentation, coding, and billing of professional services. Conducts claim reviews and chart assessments, collaborating with providers to resolve issues.
Key responsibilities:
- Researches and responds to coding, documentation, compliance, and reimbursement inquiries
- Provides compliance and documentation education sessions to physicians and staff
- Clarifies ambiguous clinical data and provides feedback for improved documentation
- Resolves billing discrepancies and issues with insurance providers
- Collaborates with healthcare providers to gather necessary claim documentation
- Updates billing software with relevant patient and insurance information
Requirements:
- Bachelor's degree preferred
- CCS-P or CPC certification required
- Strong knowledge of Evaluation & Management billing standards, medical terminology, and CPT-4 coding
- 5 years of physician billing experience preferred
- 1 year of education/teaching-related experience required