Medical Biller

Job Title : Medical Biller

2 Week Temp to Hire-Ask for Details***

Background check required

Job Summary:

The Medical Biller/Coder is responsible for accurately translating medical procedures, diagnoses, and services into universally accepted billing codes. They ensure that insurance claims are prepared and submitted in a timely and compliant manner, facilitating the revenue cycle and reimbursement process for healthcare providers.

Key Responsibilities

Coding:

Medical Coding

· Assign appropriate CPT (Current Procedural Terminology), ICD (International Classification of Diseases), and HCPCS (Healthcare Common Procedure Coding System) codes to medical diagnoses, procedures, and services.

· Follow coding guidelines and conventions to ensure accuracy and compliance.

Review Medical Records

· Analyze medical records and provider documentation to identify relevant codes.

· Ensure coding reflects the medical necessity and completeness of services.

Code Updates

· Stay up-to-date with coding updates, guidelines, and regulations.

· Incorporate changes into coding practices to maintain compliance.

Billing:

Claims Preparation

· Prepare and submit electronic and paper claims to insurance companies.

· Verify the accuracy of claim information, including patient demographics, insurance details, and coding.

Denials and Appeals

· Monitor claim status and follow up on denied or rejected claims.

· Prepare and submit appeals for denied claims, including providing necessary documentation.

Patient Billing

· Generate and send patient statements for outstanding balances.

· Answer patient inquiries regarding bills, insurance coverage, and payment options.

Documentation and Compliance:

Medical Records Review

· Audit medical records for coding accuracy and compliance with regulatory requirements.

· Identify potential documentation deficiencies and work with healthcare providers for clarification.

• Verify or modify CPT and Diagnosis coding for each patient visit.
• Verify or modify Insurance for each patient.

Compliance

· Ensure compliance with coding and billing regulations, including HIPAA.

· Verify that coding is correct in patient notes.

· Adhere to ethical coding and billing practices to prevent fraud and abuse.

Reporting and Communication:

Reporting

· Generate reports on coding and billing performance, including Key Performance Indicators (KPIs).

· Provide regular updates to management on billing and coding trends and issues.

• Post all insurance charges with corresponding date and with correct PCP.
• Post Self-Pay charges and apply patient payment to account.
• Post EOB (Explanation of Payments) for HMO/Private and make sure the balance is correct.
• Apply Copayments and deductibles to patient’s account.
• Write notes regarding copayments and deductible balances for front desk to

charge patients.

Communication

· Collaborate with healthcare providers, clinical staff, and insurance companies to resolve coding and billing inquiries.

· Generate and follow up with patient and parent of patient correspondence for current billing.

· Maintain clear and effective communication with the healthcare team and parents regarding documentation and coding concerns.

• Call insurance or Parents if there are any questions regarding claims.

·

Qualifications

· High school diploma or equivalent; completion of a medical coding and billing program is preferred.

· Knowledge of medical coding systems (CPT, ICD, HCPCS) and familiarity with medical terminology.

· Proficiency in medical billing software and electronic health record (EHR) systems.

· Strong attention to detail and analytical skills.

· Knowledge of healthcare compliance and regulations, including HIPAA.

· Excellent communication and interpersonal skills.

· Ability to work independently and as part of a team.

Benefits

Our strong benefits package is designed to give you peace of mind and help you thrive, both professionally and personally. We provide a robust benefits package that prioritizes employee

well-being:

-Retirement with a match

- Paid Time Off

- NY Sick Leave

- Health Insurance Benefits

- Weekends Off

- Employee Assistance Program

- Financial Fitness

- Working Advantage

- Tickets at Work

We're proud to offer a full range of benefits designed to support our team members.

Jesus M Pichardo Pediatrics Center prides itself on diversity and is an equal opportunity employer and considers all qualified applicants for employment without regard to race, color, religion, sex, (including gender identity and pregnancy), national origin, age, sexual orientation, disability, or veteran status.

Job Type: Full-time

Pay: $19.00 - $22.00 per hour

Benefits:

• 401(k)
• Health insurance

Work Location: In person