Job Description

Insight Global is looking for a Senior Medical Biller and Coder who has outpatient clinic and infusion services experience. Reporting directly to the CFO, the Senior Medical Biller & Coder processes the claims and coding for clinical and infusion therapy services including: processes claims for every billable visit codes the claims to the most appropriate level; sends the claims through the EMR for submission to the appropriate insurer; follows-up on the claims to ensure timely processing; works with the insurance companies for any denied claims; and enters payments into the EMR.

The Senior Medical Biller & Coder maintains appropriate accreditation for the role and any required licenses and certifications, and abides by county, state, and federal billing and coding regulations and the standards set by the following: Centers for Medicare & Medicaid Services (CMS); California Children's Services (CCS); Genetically Handicapped Persons Program (GHPP); and all other State and Federally sponsored programs. The Senior Medical Biller & Coder is familiar with industry standards and all types of payers (e.g., commercial; government; Medicare; Medicaid).

Responsibilities

1. Code and process all billable visits using accurate E&M, CPT, ICD-10 and other billing codes and standards following timely filing guidelines, policies and procedures.

2. Work directly with the Triarq billing service to submit claims, timely review and follow-up on denied or delayed claims and postpaid claims. Track all claim submissions through the Practice Management (PM) aspect of the Electronic Medical Record (EMR) system.

3. Stay up to date on industry standards set by the Centers for Medicare & Medicaid (CMS), commercial insurance plans, Medi-Cal and county managed care plans by attending seminars, conferences and other programming related to claims and billing.

4. Prepare regular reports (weekly, monthly) and participate in regular meetings on the status of claims and the financial impact of timely filing, lack of documentation and other things that can impact payment.

Role is Paying between 30-36/hr depending on experience

Transition from onsite to hybrid work after initial onboarding and training period.

REQUIRED SKILLS AND EXPERIENCE

* High School diploma or equivalent

* Graduate from an accredited school or program in Medical Billing and Coding

* 5 years of experience in outpatient clinic billing and coding

* 2 years of experience in infusion services billing and coding

* Experience working with all payers -- commercial, government, Medicare, Medicaid

* Working knowledge of CMS regulations and requirements regarding billing and coding

* Knowledge of CCS/GHPP/Medi-Cal regulations and requirements, and understanding of third-party payer methods and regulations

* Knowledge of E&M, CPT & ICD-10 codes related to Hematology and related services

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