Proliance Surgeons

Revenue Cycle Specialist

• Oversee revenue cycle processes including charge entry, billing, claims, patient accounts receivable, and insurance accounts receivable
• Verify claim information before billing
• Review surgical coding for accuracy before billing
• Process primary, secondary, and tertiary claims and address edits or rejections
• Post patient, insurance, and third-party payments
• Resolve insurance and self-pay credits
• Process bad debt
• Answer phones
• Complete assigned duties and assist others as directed
• Follow policies introduced during onboarding, updated in real time, and outlined in the Teammate Handbook

General

• Reviews/audits and interprets medical record documentation to identify pertinent diagnosis/procedure and apply correct ICD10, CPT-4, and HCPC’s codes in accordance with government and insurance regulations.
• Demonstrates appropriate utilization of coding software and coding reference material.
• Follow up with providers on any documentation that is insufficient, missing, or unclear.
• Assists providers with questions regarding coding and documentation guidelines. Provides ongoing feedback based on observations from coding documentation and identifies opportunities for education and communicates trends to leaders.
• Keeps up to date on carrier policies/guidelines to ensure all coded services meet appropriate Medicare, National Correct Coding Initiative (NCCI) or Payer-specific guidelines.
• Reviews and resolves suspended charges due to claim edits or payor rejections related to coding.
• Reviews, corrects and appeals coding-related denials trends and shares with leadership, and team members to facilitate root cause analysis and continuous process improvement.
• Corrects and/or appeals denied claims due to coding errors
• Other duties as assigned

Revenue Cycle Specialist

Coder, CPC