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The MGPO Professional Billing Office is the central billing office for physician practices affiliated with Partners Healthcare members including the Massachusetts General Hospital in Boston, Massachusetts, Newton Wellesley Hospital and North Shore Medical Center.
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The MGPO Professional Billing Office is located in the Charlestown Navy Yard campus. Supports the integration of new physicians/practice(s) into the PBO by providing professional charges by CPT code to PeC for dictionary modifications; assisting in the orientation/training of practice staff (coordinating with credentialing staff, Cadence, Ambulatory, Patient Service Center, Partners PeCare team.
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Excellent knowledge of CPT coding, ICD.10 coding and medical pre-certification protocols required. Summit Spine and Joint Centers is a rapidly expanding Pain Management Group looking to add an experienced Medical Billing Specialist to our team.
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Knowledge of Radiology CPT coding and billing issues. Kelsey-Seybold Clinic is Houston’s fastest growing, multispecialty organization with more than 40 premier locations and over 65 specialties.
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We are looking for a Billing and Coding Specialist to review claims data to ensure the assigned procedural and diagnosis codes meet required legal and standardized insurance rules. Understands the Athena billing and coding and related modules, including patient registration and guarantor snapshot.
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This position ensures that the documentation is in compliance with Medicare/Medicaid billing regulations, and provider documentation guidelines, CPT documentation and CMS coding guidelines.
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Audites a random sampling of palliative care records for correct CPT codes weekly and reports deficiencies to the Chief Clinical Officer and PFS. Reviews EMR of memory partners free text diagnosis and enters ICD-10 codes.
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The Medical Billing and Coding Specialist performs all phases of medical billing, including charge entry, claims submission, rejections, payment posting, denial management, patient and insurance accounts receivable follow-up, and patient statements and collections.
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In-depth knowledge of Medical Billing and Coding systems and procedures, including CPT, ICD-10, HCPCS coding, and more. Certified Billing and Coding Specialist (CBCS) Certification is preferred (not required.
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Supports the billing department with: CPT coding and billing reimbursement advice and assistance, government and commercial payer inquiries, internal audits, prepayment reviews and recoupments, management of 3rd party billing and coding audits, monitoring and analyzing trends in claim submissions to identify payment inconsistencies or errors and the corresponding corrective actions, and identification of areas where training and education are needed.
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Minimum of two years of experience as a nurse practitioner utilizing full scope of practice preferredClinical home care experience or two years managerial experience preferredDemonstrated knowledge of Hedis and QARR quality measures, ICD-10 and CPT coding for reimbursement of services requiredBilingual skills, as determined by operational needs requiredFor Mental Health only:Minimum of two years of experience as a psychiatric nurse practitioner utilizing full scope of practice required.
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Analyze and resolve specific billing edits that require HCPCS/CPT coding based on the chargemaster expertise and that are delaying claims from processing in the Patient Accounting and/or Relay Health systems.
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Ensures accurate, timely and appropriate assignment of ICD-10, CPT/HCPCS codes and modifiers for the purpose of billing and compliance with regulatory and payer guidelines. Completes billing for Ryan White services.
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Reviews documentation in the medical record to determine ICD-10 CM and CPT-4 coding that is needed to comply with billing and reimbursement guidelines set forth by government entities. Appropriately utilizes CPT-4 and ICD-10 current procedural coding standards in assisting the provider with proper selection and assignment of the principal procedure(s) and related diagnosis.
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Assign appropriate ICD-10, CPT, and HCPCS codes to medical record documentation by applying physician specialty coding rules, third party payor guidelines, APC billing rules and Medicare Local Medical Review Policies.
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