Professional Billing Representative (PRN | As Needed)

12211 Plum Orchard Drive, Silver Spring, MD 20904. Department 10121 Patient Cash Application.

About the Role

The Professional Billing Specialist will be responsible to ensure physician claims are complete, accurate and billed within the expected time frame according to internal billing policy, Federal and State regulations and Managed Care contract guidelines. Will be well-versed in HIP AA standards, NCCI coding and billing regulations for professional service claims to include hospital, specialty and primary care based services. Will develop detailed understanding of assigned managed care contractor and payor requirements. Will track and report billing trends with assigned carriers.

Responsibilities

• Monitor claims outstanding and report daily using various sorts to manage daily claim volumes and timelines according to policy.
• Monitor claim errors by Form and report trends, new incidents, duplications, incorrect payer mix and unusual volumes.
• Research and take action on all failed claims to bill or pend on hold for additional information by the end of the import day.
• Follow-up and resolve claims in Held status daily.
• Bill secondary claims no less than twice a week.
• Maintain age less than 5 days from import.
• Process 150 to 200 claims addressed per day contingent on assignment.
• Coordinate supporting documents to ensure validity for services billed.
• Audit claim details for standard claim data prior to submission to ensure accuracy and complete edit satisfaction.
• Follow written procedure, payer policy, guidelines and edit instruction completely.
• Stay abreast of payer updates on at least a quarterly basis and share changes with Leadership and Team.
• Research coding errors using CPT and ICD guidelines, Craneware and NCCI tools, Medical Records and Account Systems.
• Following procedure pursue authorization for code corrections.
• Apply data corrections to claim and/or host systems performing transaction updates/same claim or charge corrections/new claim as outlined in procedures.
• Apply claim notes to provide detailed explanation to downstream users when claims are pending corrections (Held claim) or not billed (Archive/Del).
• Document the: (1) Problem, (2) Research, (2) Findings, (3) Action Taken, (4) FU plan.
• Coordinate submission of supporting documentation, e.g., treatment plans, operative reports, EOB.