Medic Management Group

Medical Billing and Coding

• Read and understand explanations of benefits to perform medical billing functions.
• Knowledge of CPT, Modifiers, and ICD-10 codes.
• Assure all charges are entered within 24-48 hours of receipt from the physicians/providers.
• Make necessary changes to patient accounts (address, name, telephone number, and insurance changes, etc.)
• Assure all claims are sent electronically on a daily basis.
• Review and work claim edits and rejections on a daily basis.
• Paper claims are sent on a weekly basis.
• Patient statements are sent on a monthly basis or weekly based on volume.
• Post all insurance and patient payments within 24-48 hours of receipt (batched by date of receipt and daily balancing is required).
• Work all denials at the time of receipt.
• Prepare and send appeals.
• Begin insurance follow-up at 31 days for claims.
• Answer telephone calls regarding all medical billing inquiries.
• Submit copies of overpaid accounts to Billing Manager for review.
• Work patient AR based on the practice policy.
• Send accounts to collection based on practice policy.
• Maintain strictest confidentiality of patient private health information (PHI) by disclosing only information requested.
• Handle all electronic processes relating to claims submission, remit posting etc.
• All practice records received should be scanned to client folders on the company network drives.
• Performs additional duties as requested by upper management.

Medical Billing A/R Specialist – FQHC Experience Required

Provider Enrollment Specialist

• Credentialing new and established health care providers
• Maintenance of information including application completion, follow up, data collection, data entry, and document review
• Establish and maintain data entry in CAQH
• Prepare credentialing applications for all initial applications and reappointments in a timely and complete manner
• Verify provider and group information with insurance companies
• Coordinate information for enrollment and terminations of all providers
• Maintain good rapport and professional communication with Health Plan Representatives
• Handle enrollment with Medicare, Medicaid, and commercial insurances in multiple states
• Build strong working relationships with medical facilities and provider offices
• Adhere to department policies and procedures including timely delivery of completed work and use of resources
• Responsible for entering, updating, maintaining NPI and any other applicable provider numbers
• Provide concise, timely communication to appropriate leadership regarding potential credentialing issues
• Proactively share knowledge with colleagues
• Perform analysis and appropriate follow-up of each initial application and reappointment
• Work with physicians, professional staff and physician's office staff to acquire necessary materials and information

Provider Enrollment, Credentialing Specialist

Revenue Operations

• Responsible for the revenue cycle for assigned accounts
• Manage a team of Billing Specialists and collaborate with the Management team and supported departments to accurately capture reimbursement opportunities
• Promote growth of Team Members through established developmental goals, competencies, guidance, and counseling
• Act as coach, leader, catalyst, and facilitator with Team Members
• Provide analytical, practical, and operational experience with private practice revenue cycle
• Provide direction to team members and organize the billing function to maximize departmental productivity
• Conduct regular productivity analysis and audits for assigned billing team
• Manage department, including problem solving, administering procedures to increase efficiencies, and implementing new systems to ensure accountability
• Review payor denials, making required corrections in billing system(s) by obtaining necessary contract documentation
• Ensure all bills/claims received by billing team are expediently logged, prioritized, and verified according to established policies and procedures
• Ensure billing team follows MMG Billing Policies as well as Client Policies
• Train team on specifics of each contract, changes in policies and procedures, industry or regulatory changes to ensure compliance
• Identify and facilitate problem solving and conflict resolution
• Ensure continual payor maintenance
• Participate in payor reimbursement meetings and/or conferences relating to Medical Billing and Accounts Receivable as requested
• Audit, research, and reconcile setup and required maintenance of the billing system(s) including any payer contract changes
• Generate standard reports, and review each for accuracy and consistency with the billing system(s)
• Communicate and meet with practices to review account activity/issues
• Conduct professional meetings, prepare agendas and provide minutes to meetings
• Analyze accounts MTD/YTD activity and address concerns regularly
• Maintains and ensures compliance to regulatory standards
• Abide by HIPAA standards and requirements
• Monitor monthly cash collections by payor to eliminate potential payor issues.
• Participates in professional development efforts to ensure currency in health care practices and trends.
• Participate in LinkedIn posts and articles.

Medical Billing A/R Specialist – FQHC Experience Required

Provider Enrollment, Credentialing Specialist

Revenue Cycle Manager, FQHC Experience