Anne Arundel Dermatology

Accounts Receivable

• Responsible for all aspects of insurance follow-up and collections, including making telephone calls, accessing payer websites.
• Identify root cause issues for denials; categorize denial reasons and coordinate with clinic and/or with management to ensure process improvements are completed.
• Owns performance and ensures consistent and timely communication for issues identified affecting reimbursement.
• Effectively resolve complex or aged inventory, including payment research, payment recoups with minimal or no assistance necessary; accurately and thoroughly document the pertinent collection activity performed.
• Review the account information and necessary system applications to determine the next appropriate work activity.
• Verify claims adjudication utilizing appropriate resources and applications.
• Edit claims to meet and satisfy billing compliance guidelines for electronic submission.
• Manage and maintain individual work list/inventory, complete reports, and resolve high priority and aged inventory.
• Stay informed of changes with the procedures and laws for the specific insurance carriers or payers.
• Effectively communicate issues to management, including payer, system or escalated account issues as well as develop solutions.

AR Specialist

Auditor

• Supports codes from final surgical/procedural operative reports signed by the provider.
• Reviews the complex (problematic coding that needs research and reference checking) medical records, ensures documentation is supported.
• Works with ModMed to ensure that the correct plans are used, modifiers attached and diagnosis attached.
• Audits provider medical records and charges for compliance with coding and documentation standards to ensure compliance with internal and government regulations.
• Provides continuing review and education of physician and ACPs to ensure appropriate level of care is reported.
• Partner with practices to review findings of the periodic chart review.
• Maintains a thorough understanding of anatomy and physiology, medical terminology, disease processes and surgical techniques through participation in continuing education programs to effectively apply ICD-10-CM and CPT coding guidelines to diagnoses and procedures in offices.
• Correlates information supporting clinical documentation not limited to Pathology, Radiology and/or other Physician Consultations after review by the Attending Physician, wherever appropriate.
• Regularly meets with physicians and ACPs to provide continuous education on billable services, medical record documentation, the correct use of CPT and ICD-10 codes, missed billing opportunities and erroneously reported services to minimize errors and loss of revenue.
• Interacts with and provides trends to management, revenue managers and others about coding related issues.
• Solves any coding related problems and/or answers questions regarding coding issues from the provider, office staff and billing specialists.
• Collaborates with billing specialists and appeal and edit coders to expedient resolution of accounts.
• Works together with billing specialists to develop plans to improve charge capture and billing/coding processes.
• Stays current with CPT and ICD-10-CM coding guidelines and updates.
• Communicate changes and/or updates to key stakeholders including physicians, ACPs, practice managers and leadership.
• Reports any potential compliance issues to the Director of RCM.

AR Specialist

Provider Coding Auditor, Educator