What you’ll do

• Manage inbound eligibility and pre-authorization checks for new patients
• Ensure eligibility and precheck are performed in a timely manor
• Manage month end billing activities, including but not limited to: running reports on patient care, translating patient care activities to billable codes, developing billing reports, creating and submitting claims to insurance
• Communicate with client practices to answer billing questions related to process, compliance, denials, etc.
• Establish and manage to KPI’s, e.g, reimbursement rates, denial resolution rates, error rates, compliance
• Independently create new policies and procedures as needed to improve KPI’s and address any critical issues
• Stay up to date on new codes, coding and revenue trends and responsible for keeping the practice administrator and clinical staff educated on coding/ billing requirements and changes
• Work closely with Finance to reconcile receivables and revenues
• What about working with with Patients to directly resolve issues
• Apply your knowledge as a Certified Professional Coder to investigate and resolve coding related insurance payment denials
• Develop and oversee payment reports to manage AR
• Perform retrospective coding and documentation review of denied charges for physician services
• Review medical records for completeness and accuracy to ensure documentation supports the services billed and all documentation standards are met for billing
• Performs extensive follow-up to investigate and resolve payment denial trends
• Resolves outstanding accounts utilizing ancillary applications and websites as tools to retrieve medical documentation, claim status and billing guidelines to substantiate corrected claim submissions, written appeals, coding and medical necessity reviews
• Researches and interprets payer contract terms and compiles necessary supporting documentation templates for appeals according to various payer claim guidelines
• Ensures denial reviews are conducted in a timely manner
• Maintains up-to-date policies and procedures and knowledge related to managed care and third party payors
• Participates in annual and on-going mandatory compliance training
• Fulfills Continuing Education Units necessary to maintain certification status
• Assists in training current and new employees on the use of systems and departmental policies and procedures
• Performs other related duties as assigned

Qualifications

• Deep knowledge of digital health, telemedicine, remote patient monitoring/remote therapeutic monitoring and chronic condition management billing is required
• Remote based work with rare onsite requirement
• RCM Experience:
• Approximately 3-5 years of physician billing experience, specifically accounts receivable and collection experience
• Knowledge of medical terminology and third-party reimbursement
• Proficient in CPT and ICD10 CM coding guidelines
• Knowledge of medical terminology and third-party reimbursement
• Technology and Processes:
• Strong computer skills in data entry, coding, and analytics
• Prior experience working with an EMR systems, specifically AdvancedMD
• Prior experience working with eligibility and prior authorization workflows and technology (e.g. Availity)
• Proficient in Google Workspace (Sheets, Gmail, Docs, etc.), and Microsoft Office (Excel, Word, PowerPoint)
• Working and Personal Skills:
• Demonstrated ability to function independently and exercise independent judgment
• Demonstrated critical thinking and analytical skills
• Ability to meet daily coding and denial management production requirements along with quality as per Company norms
• Ability to follow coding guidelines and legal requirements to ensure compliance with our Institutional, federal, and state regulations
• Excellent interpersonal, verbal and communication skills

Education

• High school diploma or GED in related field

Licenses and Certifications

• Certification as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS)
• Should be certified from AHIMA or from AAPC

Benefits

• Annual Discretionary Performance Bonus
• Comprehensive health, dental and vision policies
• Up to 15 PTO / 5 Sick Days / 12 Company Holidays off to encourage people to rest and reset
• 401K Matching Program
• Complimentary Mend products

About mend™

mend™ is a life sciences and biotechnology company that harnesses the power of nature to supercharge health and healing for everybody. Our nature-powered supplements are clinically-proven and recognized by the medical community to be effective in accelerating repair, recovery, and improving key risk factors that contribute to chronic conditions. mend™ works with leading hospitals and universities on developing evidence-based clinical nutrition products to enhance patient outcomes. Which is why we’re such a hit with high-impact individuals in sports, the military, and anyone living an active life. We are committed to educating the world about the power of natural ingredients as a complement to medical treatment. We make it easy for people to use nature to power themselves back to health. And to stay healthy on the daily.