Clinic Billing Services
8 Hour Shift
Rancho Mirage, CA
Job Objective: A brief overview of the position.
Responsible for researching and resolving claim denials, ADR requests and certs, submitting and tracking appeals, noting trends and providing monthly reports .Maintains a Library of Payer reference material regarding requirement for pre authorization, medical necessity and documentation requirements. Works with the coding team and Provider Liaisons to provide information to Physicians and Extenders related to denials and opportunities to reduce same.
Director Clinic Billing Services
Ages of Patients
Blood Borne Pathogens
Minimal/ No Potential
Required: High School diploma or equivalent
Preferred: Associate degree
Preferred: Certified coder or currently enrolled in a coding program
Required: Minimum of two years of Professional Billing with an emphasis in Managed Care denial follow up and appeals processing Prior hospital billing experience a plus.
Preferred: three to five years of Patient Accounting in a high volume environment.
Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations
Analyze denied, underpaid and unpaid claims. Appeal underpaid and denied claims within timely filing periods
Identify, track and report on denial trends
Maintain an appeals data base to identify and report outcomes and opportunities
Identify any coding trends resulting in denials and report to the Coding manager
Identify any other trends resulting in denials and report to Clinic PFS Director
Attend all available coding and appeals related seminars as available