Claim Readiness Specialist

Westchester, IL

About the position

The Claim Readiness Specialist is responsible for entering and importing charges and ensuring the appropriate billing codes are used for all charges. The Claim Readiness Specialist will ensure charges are entered accurately, efficiently, and timely into the practice management system. The Claim Readiness Specialist is also responsible for resolving all assigned claim edits and submission of claims to third party payers within the clearinghouse/practice management system in a timely and efficient manner. They work with the Coding and Revenue Integrity Supervisor to escalate charge entry and bill submission issues to prevent incorrect billing. This role reports to the Revenue Integrity Supervisor.

Responsibilities

• Enters and imports charges daily for all professionals ensuring accurate coding.
• Determines correct CPT codes for professional surgical procedures along with Evaluation and Management (E&M) clinical encounters.
• Determines appropriate ICD-10 diagnosis codes.
• Ensures all prior day’s charges and edits have been accurately resolved and claim is ready to bill insurance in a timely manner.
• Identifies root cause issues causing charge edits and communicates these issues to leadership for upstream education.
• Communicates with Coders, Business Office staff, and Providers when necessary to resolve errors and clarify issues.
• Stays accountable to quality and productivity standards, and monitors compliance with policies and procedures.
• Identifies process opportunity trends and recommends ways to improve efficiencies.
• Ensures adherence to third party and governmental regulations relating to coding, billing, documentation, compliance, and reimbursement.
• Participates in special projects, personal development training, and cross training as instructed.
• Informs Supervisor, Coding and Revenue Integrity of trends, inconsistencies, discrepancies for immediate resolution.
• Works in conjunction with peers and functional areas of the Coding and Revenue Integrity department for the betterment of completing tasks and the company overall.
• Job may require other duties as assigned.

Requirements

• High School Diploma or equivalent required.
• Minimum of three years revenue cycle experience within a physician practice.
• Minimum 2 years hands-on coding and/or billing experience within a physician’s office and/or successful completion of secondary education in medical coding/billing or medical administration, or urology experience.
• Certified Professional Coder (CPC) preferred.
• Demonstrates and uses a strong working knowledge of CPT coding and ICD10 coding as it relates to urology services.
• Excellent verbal and written communication skills.
• Excellent organizational skills and attention to detail.
• Strong analytical and problem-solving skills.
• Skill in using computer programs and applications including Microsoft Office.
• Ability to work independently and manage deadlines.
• Ability to follow policies and procedures for compliance, medical billing, and coding.
• Ability to type and enter data with proficiency and accuracy.

Nice-to-haves

• Experience in Urology or physician practice environment preferred.

Benefits

• Health insurance
• Dental insurance
• Vision insurance
• Life Insurance
• Pet Insurance
• Health savings account
• Paid sick time
• Paid time off
• Paid holidays
• Profit sharing
• Retirement plan
• Free parking