Crossroads

Medical Billing and Coding

• Performs all duties and responsibilities in accordance with local, state, and federal regulations and company policies
• Utilize and apply industry knowledge to resolve new and aged accounts receivables by working various account types, including but not limited to professional claims, governmental and/or non-governmental claims, denied claims, aged accounts, high priority accounts, high dollar accounts, reimbursements, credits, etc.
• Leverage available resources and systems (both internal and external) to analyze patient accounting information and take appropriate action for payment resolutions, document all activity in accordance with organizational and client policies
• Communicate professionally (in all forms) with payer resources to include websites/payer portals, e- mail, telephone, customer service departments, etc.
• Maintain quality and productivity results at a level that meets departmental standards as measured by a daily/weekly/monthly average
• Reviews claims data and supporting documentation to identify coding and/or billing concerns
• Ability to interpret payer contracts and identify contract variances affecting reimbursement
• Utilize knowledge of the cash posting processing to obtain the necessary information to resolve misapplied payments
• Demonstrate clear proficiency in third-party billing requirements to include federal, state, and commercial/managed care payers
• Interpret claim scrubber edits/rejections and takes appropriate action necessary to resolve issues
• Seek resolution to problematic accounts and payment discrepancies
• Prepare appeal letters for technical denials by accessing specific payer appeal forms, submitting appropriate medical documentation, and tracking appeal resolution
• Analyze accounts with critical thinking; consider payer contracts and billing guidelines to ensure one-touch resolution
• Further responsibilities may include reviewing insurance credit balances to determine root cause and take the steps necessary to resolve the account
• Identify denials trends, root cause, and A/R impact
• Serve as a resource to other team members and assist Team Leads with identifying A/R and denials trends
• Other Duties as Assigned.

Accounts Receivable Specialist – Medical Billing

Counselor

• Provides individual counseling to highly complex patients
• Conducts clinical assessments to appropriately assess patient’s treatment needs
• Designs and updates the patient’s treatment plan, including care coordination, referrals, and discharge planning
• Manages assigned caseload and compliance with clinical treatment requirements
• Collaborates with nurses and providers to provide holistic treatment services
• Facilitates urine drug screening for patients

Accounts Receivable Specialist – Medical Billing

Substance Abuse Counselor – OTP