Role Summary The Insurance Administrator is responsible for Medical Coding, Billing, Claims at the clinic. The role ensures timely and accurate billing, submission of claims, reconciliation of payments, and compliance with healthcare regulations. This position plays a vital role in optimizing the revenue cycle, minimizing claim denials, and ensuring financial efficiency within the clinic. It requires strong multitasking skills, effective communication, and keen attention to detail to maintain both operational accuracy and efficiency. General Duties Performs other appropriate and related duties as assigned by the Reporting-Head to meet departmental objectives Continuously look for ways to streamline and improve workflow Assist with quarterly/annual audit as required without compromising the regular clinical activities
Accurately code patient procedures, diagnoses, and treatments using ICD-10, CPT, and HCPCS coding systems. Assist with patient insurance verifications and pre-authorizations for services. Ensure the collection of co-pays, deductibles, and any outstanding balances from patients. Ensure reports are submitted on a daily basis. Overseeing and managing the Insurance, billing & coding department to ensure accurate and timely coding of medical records, submissions, receiving payments, reconciliation and denial management. Provide ongoing training and resources to the Insurance, billing & coding team and guidance to physicians, nurses, and other healthcare professionals to improve understanding of coding & billing guidelines and practices. Track key performance indicators (KPIs) for billing accuracy, timeliness, and productivity, implementing corrective actions as needed. Identify and address Insurance, billing and coding-related compliance issues. Conduct regular audits to ensure billing and coding accuracy and compliance with coding guidelines and regulations to identify areas for improvement. Stay informed about advancements in billing & coding technologies and software to improve operations. Stay informed about evolving billing & coding standards, payer policies, and regulatory changes, ensuring the team adheres to them. And develop and maintain billing & coding policies and procedures. Collaborate and work with other departments, including but not limited to clinical documentation, Laboratory, Radiology, Pharmacy and compliance to ensure seamless communication and address billing & coding-related issues. Develop and implement strategies to enhance billing & coding efficiency, productivity, accuracy and the overall revenue cycle.
Implementing process improvement technologies as necessary. Participate in the hiring and onboarding of new staff. Maintain accurate and confidential patient billing records. Generate reports on billing performance, outstanding claims, and revenue collections. Liaise with insurance companies to resolve claim-related issues. Support front desk and patient inquiries related to billing, coverage, and balances. Performs other related duties incidental to the work described herein as and when assigned by the Administrator. Carries out any other duties assigned by the Reporting-Head.
10+ years of experience in healthcare facility. Strong knowledge of ICD-10, CPT codes. Excellent communication and interpersonal skills. High attention to detail, accuracy, and ability to meet deadlines. Problem-solving skills to resolve billing discrepancies and denied claims. Master’s/ Bachelor’s Degree, CPT, CPC, COC Certification in medical coding/billing with 10+ years of experience in medical coding, billing, or claims management within a hospital or clinical setting.
17 days remaining
