Medical Billing and Prior Authorization Specialist
About the Company
CardioOne partners with independent cardiologists to provide innovative solutions that improve patient outcomes and reduce costs. Our value-based cardiology care solutions help our physician partners thrive in the shift to value-based care. CardioOne offers a magnificent work environment, good working conditions, and competitive pay. We offer medical, dental, vision, and a 401k plan w/match to benefit eligible employees. We offer PTO (Personal Time Off) and sick time to full-time employees. We take pride in creating a culture of employee engagement that translates into an exemplary patient experience. Join us in our mission to positively impact US cardiology.
About the Job
Cardiovascular Specialists of New England is seeking a detail-orientated Medical Billing and Prior Authorization Specialist to join our team! The ideal candidate will have a demonstrated knowledge of medical billing, preferably in cardiology services. We seek an organized critical thinker with billing knowledge and who is comfortable working with providers, insurance companies, and in a fast-paced environment. This role offers an exciting opportunity to dive into the heart of healthcare finance, where you'll play a crucial part in our practice's success while developing valuable skills for your future career growth. With Prior Authorizations, you will be responsible for obtaining prior authorization from payers for Cardiology services. You will report directly to the Senior Director of RCM Implementation and Optimization.
What you’ll do:
- Create and maintain patient records sufficiently to support billing
- Map insurance information from hospital records to the practice EHR
- Contact patients where additional insurance information is required
- Answer patient inquiries regarding balances
- Work in multiple computer systems to obtain and organize information to support billing
- Resolve claims that require pre-bill resolution
- Resolve payment denials
- Oversee billing-related inventories in multiple systems, ensuring inventory volume and aging remains within thresholds
- Conduct reconciliation processes, ensuring no charge goes uncaptured
- Manage communications between practice and vendor staff and organizations
- Confirms and documents the need (or lack of) for an authorization and takes the appropriate actions to ensure the authorization is obtained.
- Prioritizes the urgency of the authorization by anticipating the approximate time it may take to obtain the authorization from the insurance company, the complexity of the procedure and the scheduled date of service; follows up with insurance company to accelerate responses and expedite urgent authorizations.
- Solid understanding of insurance verification, insurance registration workflows, and prior authorization requirement.
What you’ll need:
- High school diploma or GED preferred
- A passion and proficiency for medical billing, coding, and terminology
- Knowledge of ICD-10 and CPT codes, and modifiers
- Experience with medical office procedures and medical collections
- Comfort with electronic medical records systems (Athena knowledge is a bonus, Hybrid Chart familiarity is the cherry on top)
- Strong attention to detail and accuracy in data entry
- Intermediate knowledge of Microsoft Word and Excel
- Excellent communication skills to interact with patients, insurance companies, and healthcare providers
Work Location:
You will work out of the Manchester or Londonderry, NH office based on needs of the offices.
Additional Information
Full-time base hourly rate of $20.00 to $24.00 per hour plus medical, dental, and vision.
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