Job Summary: We are seeking an experienced
Rheumatology Medical Biller Specialist with over 5 years of experience in medical billing and coding, specifically in rheumatology. The ideal candidate will possess in-depth knowledge of billing procedures, insurance guidelines, and coding for rheumatology-specific services such as infusions, diagnostic imaging, and lab tests. This role requires precision, organization, and a deep understanding of revenue cycle management to ensure accurate billing and prompt reimbursement.
Key Responsibilities: - Specialized Billing & Coding: Accurately process claims for rheumatology services, using ICD-10, CPT, and HCPCS codes for treatments like biologics, infusions, and diagnostic procedures.
- Claims Management: Submit, track, and resolve unpaid or denied insurance claims, ensuring adherence to Medicare, Medicaid, and private insurance policies.
- Prior Authorizations: Coordinate and secure pre-authorizations for medications and treatments commonly used in rheumatology practices.
- Accounts Receivable Management: Monitor and manage patient accounts, post payments, and ensure timely follow-up on outstanding balances.
- Insurance Verification: Confirm insurance eligibility and benefits for rheumatology-specific procedures and treatments.
- Compliance & Regulations: Ensure compliance with HIPAA regulations and current billing standards, including knowledge of payer-specific guidelines.
- Provider Communication: Collaborate with rheumatologists and other healthcare providers to resolve coding and billing discrepancies.
- Reporting: Generate reports on billing trends, revenue cycle performance, and areas for optimization.
Qualifications: - Experience: A minimum of 5 years of medical billing and coding experience, with at least 2 years in rheumatology or a related specialty.
- Certification: Certified Professional Coder (CPC), Certified Medical Reimbursement Specialist (CMRS), or Certified Coding Specialist (CCS) preferred.
- Technical Proficiency: Proficient in EHR/EMR systems, medical billing software (e.g., Kareo, AdvancedMD, or similar), and Microsoft Office Suite.
- Knowledge: Advanced understanding of rheumatology-specific billing codes, treatments, and procedures.
- Skills: Strong attention to detail, problem-solving abilities, and excellent communication skills.
- Location: Must reside in Texas and be available during CentralTime business hours.