PFS Billing Specialist
PFS Billing Specialist
Primary Location Atlanta, Georgia
Job Number 1103635
Date posted 12/19/2022
Description:
The duties of this role include PFS Billing operations and quality control checks during the billing process. The PFS Billing Specialist processes modifies, and processes all downloaded claims after analyzing, looking into, and resolving the daily priority error burden. removing all billing-specific claim mistakes from all ePREMIS interactions and the Claim Edit WQs allocated to Billing.
Significant Duties:
Electronic Data Inputs (EDI) and other relevant rejections are examined and corrected.
Enter into the billing system all applicable patient care charges.
Process all unread IM. Bill members for missing documentation after core hospital discharge if there is any.
investigates and records the steps taken to address billing issues, as well as odd charges and credits.
searches through the databases of payers, the Membership System, and Resolute to find any missing or erroneous data. claims are updated with the new data and released for transmission to the payer.
performs audits for quality assurance and reviews bills qualitatively and quantitatively.
keeps the charge entry file system up to date.
Issues with trending accounts should be escalated to Management for prompt and effective resolution.
Act as a point of contact and resource for Visiting Member reporting throughout all regions, and submit a monthly report on denials.
gives financial coders advice and instruction on coding and billing adjustments.
accordance to departmental norms and procedures, work on high priority cases.
serves as a point of contact for collections and other denial-related departments.
Take care of the returned mail and returned mail WQ.
Read also employees expected conduct for this job
- Minimum four (4) years of billing/coding experience to include knowledge of CPT, ICD-9/10, HCPCS codes is required Knowledge of compliance medical and insurance terminology.
- Bachelor's degree OR four (4) years of experience in a directly related field required.
- High School Diploma or General Education Development (GED) required.
- N/A.
- Experience with/knowledge of Worker's Compensation and Third-Party Liability.
- Experience with/knowledge of commercial and Medicare billing procedures and regulations.
- Knowledge of Microsoft Word, Excel, and Access is required.
- Experience with/knowledge of ePREMIS and Epic (Resolute, Cadence and Tapestry).
- Familiarity with health insurance laws and regulations required.
- Knowledge of Microsoft Word, Excel, and Access is required.
- Demonstrated knowledge of CMS 1500 and UB 04 Billing Form.
- Working knowledge of related billing software (i.e., HB, PB).
- Minimum six (6) years of billing/coding experience to include knowledge of CPT, ICD-9/10, HCPCS codes is required Knowledge of compliance medical and insurance terminology.
- Billing and Coding certification, AHIMA, AAPC, preferred.
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