Medical Biller Auditor

Company: Exceptional Healthcare Inc.
Location: Dallas
Posted on: May 16, 2022

Job Description:

Exceptional Healthcare is a group of 13 Emergency Centers and two community hospitals. We are a growing company that is now in need to improve our revenue cycle for continued growth. As an independent operator of emergency care in Texas and Arizona.

General Job Description

This position is responsible for auditing medical facilities and professional claims for accuracy and compliance with industry laws and contractual language on behalf of our clients. Candidates must possess a strong understanding of Medicare and Medicare guidelines. Must display a high degree of independent judgment and professional skepticism that enhances the work performed to achieve success in this position.

MAJOR DUTIES AND RESPONSIBILITES

• Stop Loss Claims Management
• Review medical stop-loss claim submissions
• Audit claims against plan document, stop loss contract, and carrier standards
• Facilitate financing of approved claims with finance
• Pend claims and issues denials to third party administrators where appropriate
• Elevate complex claim issues for clinician or management review
• Properly documents claim file
• Claim Support
• Compile periodic reporting for internal and external parties
• Advise on claim projections and development
• Quality Assurance
• Recognize, document, and alert the appropriate supervisor of trends in claims
• Performs self-quality monitoring in order to develop and execute plans to meet established goals ----- - Meet established turnaround time and accuracy metrics
• Provides ongoing feedback to help optimize quality performance
• Collaborates with others and cross-departmentally to improve or streamline procedures
  
  Minor Duties And Responsibilities
  
  Ensure all claims are submitted daily with a goal of zero errors
  
  Timely follow up on insurance claim status
  
  Reading and interpreting an EOB (Explanation of Benefits)
  
  Respond to inquiries by insurance companies
  
  Denial Management
  
  Meet with Billing Manager/Supervisor to discuss and resolve reimbursement issues or billing obstacles Any additional duties as requested by management
  
  Qualifications For The Job
  
  Education:
  
  High School Diploma required
  
  College degree preferred
  
  Experience:
  
  3+ years of Claims Coding or Medical Billing experience
  
  Knowledge and understanding of CMS-1500 and UB-04 Medical Claim Forms; Medicare Reimbursement / Denial experience preferred
  
  AAPC, AHIMA, NHA Coding Certification, or the LAMBDA CMRS Certification required ICD-10 Proficient is required
  
  Other:
  
  Communication (written, verbal, and listening), interpersonal and analytic skills
  
  Ability to use software related to job responsibilities including MS Office with proficiency in Excel and Outlook
  
  KEY COMPETENCIES
  
  Analytical Skills,
  
  Communication
  
  Billing Knowledge
  
  Denial Management
  
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Keywords: Exceptional Healthcare Inc., Dallas , Medical Biller Auditor, Healthcare , Dallas, Texas