The Revenue Cycle Representative II is directly responsible for ensuring that all patients are financially secured by processing insurance eligibility, reviewing and updating financial demographics and classifications, submitting clean compliant claims with correct coding for charge entry, processing and reviewing system edits and reconciling charges against schedules/reports/clinical notes.
Responsible for securing account by verifying insurance eligibility using available systems such as Experian GE/IDX, Eagle and Web-based payer eligibility tools.
Completes/Updates registration in the GE/IDX system, collects defined minimum data set, including patient demographic and other identification data, insurance or other third-party payer information, if needed.
Responsible for the correct identification and selection of appropriate insurance FSCs and reviews entire account for continuity.
Reviews and submits clean electronic (CROWN) and paper encounter.
Review patient medical records assigning appropriate evaluation/management levels and procedure codes for professional services. Maintains a working knowledge of the current CPT Professional Edition and ICD-9-CM coding principles, governmental regulations, protocols and third-party requirements pertaining to billing and documentation. Ensures all services documented in the patient’s chart are compliant for correct coding.
Reconciles and corrects encounters by using CROWN pending report.
Reconciles and corrects GE/IDX TES/Ecommerce and claim reports using billing and coding knowledge.
Communicate, educate clinicians, practice managers and staff for assistance in securing account in order to submit a clean and accurate claim.
This position requires a Certification in Professional Coding (CPC) and or CCA and proficiency in Local and Federal policy guidelines and requirements for correct coding.
Minimum of two years experience in a physician billing or third party payor environment. Proficiency in health insurance benefits and eligibility requirements.
AAPC/AHIMA medical coding certification CPC and/or CCA
Working knowledge of EHR, preferably Allscripts software or comparable system.
GE/IDX experience or comparable professional billing system.
Knowledge of insurance plans and all lines of business, insurance billing requirements, worker’s compensation, Medicare and Medicaid.
Functional knowledge of basic computer operation and keyboard functions.