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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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2 years' experience in hospital setting such as Patient Access, Doctor's Office, Inpatient Unit, Patient Accounts Billing or at a related type medical institution or medical payer, e.g., BCBS, Tufts, etc.
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Strong understanding of medical coding (ICD-10, CPT, HCPCS) and insurance billing procedures. Certification in medical billing and coding (e.g., CPC, CPB) is a plus.
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Thorough knowledge of ICD-10, CPT, HCPS, and Revenue Billing Codes. The Sr. Claims Auditor utilizes CPT and ICD-10 coding to review physician claims and medical records for coding accuracy.
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4+ of coding experience in Managed Care, medical billing, facility or physician environment required. Under the general direction of the Manager of Payment Integrity, the Sr. Claims Auditor performs accurate and timely reviews of medical claims for internal audits.
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The Medical Billing Specialist is responsible for accurate claims submission, accounts receivable follow-up, payment posting, EOB and COB processing, credit balance refunds, bad debt and collections.
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Post visit work Enters charges and reviews patient record for billing accuracy performing quality checks on ICD-10 and CPT codes and other related information in order to streamline the billing process per practice protocols.
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Expert knowledge of ADA codes, CPT Codes axiUm expert; MassHealth and Medicare regulations and guidelines, as well as commercial dental/medical insurance coding/billing practices.
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Enters charges and reviews patient record for billing accuracy performing quality checks on ICD-10 and CPT codes and other related information in order to streamline the billing process per practice protocols.
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Licensure, Certification & Registration:Epic proficiency or certification in Resolute HB and/or Resolute PB desiredExperience:Requires minimum 2 years of healthcare revenue cycle experienceSkills, Knowledge & Abilities:Comprehensive working knowledge of medical/hospital billing practices, billing software, health care insurance, and CMS regulationsKnowledge of CPT, HCPCS, and ICD-10 coding principles.
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Understanding of Medical Billing, ICD and CPT coding, analytical and leadership ability, computer literacy, excellent interpersonal ability, attention to detail, organization, and a professional attitude.
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Experience with ICD-10, CPT/HCPCS codes and billing claim forms. As a WellSense Provider Relations Consultant, you’ll act as the primary liaison between WellSense’s contracted medical providers and internal WellSense departments, such as Claims, Benefits, Audit, Member and Provider Enrollment and Clinical Services.
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