2 jobs found in Westwego

Patient Account And Reimbursement Specialist Provides patient account and reimbursement services for all units of the agency that require third party and other billing-related functions (except for grants and contracts). Supervision Exercised: None Essential Functions: Review documentation for services submitted by Providers to ensure compliance with Billing Guidelines for all Third-Party insurance payers. This includes guidelines for Governmental Payers (Medicaid, Medicare), as well as Private insurance (PPO and HMO) products. Must be adaptable to Service Line expansions to ensure reimbursement requirements are met. Responsible for communicating with insurance companies, or other related entities regarding claim rejections. In conjunction with the Revenue Cycle Manager, prepares reports specific to Providers which indicate repetitive rejections that are preventable. Duties will include but are not limited to the following: processing corrective claims related to denials,...

Coding Compliance Specialist Provides coding, audit, and compliance support for all clinical services rendered by the organization. This role ensures accurate code assignment, adherence to FQHC billing and reimbursement regulations, and supports risk mitigation efforts through provider education and ongoing audit activities. None Essential Functions: Conduct routine and targeted provider coding audits to ensure compliance with FQHC billing requirements, Medicare, Medicaid, and commercial payer policies. Analyze audit findings and communicate results to Providers, including corrective action recommendations and education as needed. Serve as a liaison to Providers regarding coding updates, new services, documentation standards, and regulatory changes; must be able to present effectively to physician groups. Review all coding-related denials to identify trends, root causes, and systemic risks; recommend preventive strategies to reduce future denials. Review Athena coding...