UNKNOWN

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Ophthalmology LTD delivers treatment for cataracts, glaucoma, and diabetic eye disease, as well as cornea transplants, oculoplastic surgery, retina surgery, vitreoretinal surgery, and pediatric eye care in Sioux Falls. Minimum of 2 years of medical coding experience in a physician office setting or equivalent with knowledge of various medical payer practices and insurance laws/guidelines (Medicare, Medicaid, Work Comp, VA, and other third-party payers).

Over the years, Ophthalmology LTD's name provides the highest quality of comprehensive medical and surgical eye care. Highly trained ophthalmologists, as well as experienced optometrists, combine their considerable expertise to give each and every patient the best possible care. Ophthalmology LTD delivers treatment for cataracts, glaucoma, and diabetic eye disease, as well as cornea transplants, oculoplastic surgery, retina surgery, vitreoretinal surgery, and pediatric eye care in Sioux Falls.We are looking for a passionate Medical Coder. This person is responsible for coding clinical and outpatient medical records using the most accurate and appropriate ICD-10-CM and CPT codes in accordance with regulatory coding guidelines and Ophthalmology LTD policy and procedures. If you are passionate about the work you do and the effect your work has on a patient's experience, this might be a great fit for you! This position is full-time and will work on-site to provide you real-time opportunity to collaborate with the Ophthalmology LTD family.A summary of the job duties include:<ul><li>Demonstrate extensive knowledge of official coding guidelines established by the AMA and CMS with regard to the assignment of ICD-10 and CPT.</li><li>Evaluates medical record documentation to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflect and support outpatient visits.</li><li>Respond to coding questions/issues and reimbursement questions from clinical staff and other departments as necessary.</li><li>Performs scheduled audits of physician coding and documentation to make recommendations for improvements and enhancements. </li><li>Obtains authorizations prior to procedures or surgical services being performed.</li><li>Assist department leadership with research, analysis, and all other special projects.</li><li>Answer phone calls and direct calls to the appropriate areas.</li><li>Financial counseling of patients prior to medical services being performed and work with the Billing/Insurance Manager and/or CEO on exceptions to standard procedures.</li></ul>Education and Training requirements:<ul><li>High School Diploma, or equivalent. Prefer post-secondary education courses in Health Information Management, accounting and/or business. Educational coursework in CPT and ICD coding in medical practice and a thorough understanding of medical terminology and anatomy. </li><li>Minimum of 2 years of medical coding experience in a physician office setting or equivalent with knowledge of various medical payer practices and insurance laws/guidelines (Medicare, Medicaid, Work Comp, VA, and other third-party payers). Ophthalmology coding and billing experience preferred.</li><li>Certification is encouraged (CPC-Certified Professional Coder, OCS-Ophthalmic Coding Specialist)</li></ul>Please note this job description is not a complete listing of activities, duties, or responsibilities that are required for this job. Duties, responsibilities, and activities may change at any time.Ophthalmology LTD office hours are Monday – Friday, 8 am – 5 pm. We offer competitive compensation and a comprehensive benefits package including health, dental, 401K, life insurance, AD&D, short and long-term disability, PTO, sick leave, paid holidays, and eye care benefits. #hc172526

Ophthalmology LTD

Medical Coder

Accounting

Analysis Skills

Anatomy

Auditing

Billing

Cataract

Certified Professional Coder (CPC)

Content Management Systems (CMS)

Current Procedural Terminology (CPT)

Diabetes

Documentation

Eye Diseases/Disorders

Eye Surgery

Glaucoma

Health Education

Health Information Management

Healthcare

Healthcare Quality

High School Diploma

ICD-10

Insurance

Insurance Regulations

International Classification of Diseases (ICD)

Leadership

Medicaid

Medical Coding

Medical Office

Medical Records

Medical Terminology

Medicare

Ophthalmology

Outpatient Care

Patient Education

Pediatrics

Regulations

Reimbursement

Surgical Procedures

Telephone Skills

Third-Party Payer

Hireclick

Supervise day-to-day billing operations, analyze and review each billing cycle to ensure accuracy and timeliness; prepare supporting monthly financial reports detailing billing status for CPA; maximize reimbursement from third-party payers. Skills/Qualifications: Must possess a comprehensive knowledge of revenue cycle functions and systems, as normally obtained through a Bachelor's degree in Business or Healthcare Administration or a related field.

About Center for Family Medicine:At CFM it starts with the best care. We pride ourselves on delivering the most up to date medical treatments while treating every patient with kindness and respect. We also offer a wide array of convenient and helpful services. From the baby of your family to your eldest member, we make sure you’ll always feel good about visiting the Center For Family Medicine. As the home to the Sioux Falls Family Medicine Residency program, our clinic offers a varying patient population, a focus on education and teaching, and an emphasis on whole-patient care with the personal touch.Position Description:Hours: Monday-Friday, 8am-5pmCenter for Family Medicine is looking for an experienced Business Office Supervisor (Medical Billing). The Business Office Supervisor assigns and oversees the work of medical billing staff for the clinical office that is home to the Sioux Falls Family Medicine Residency program. They will oversee billing, coding, medical records patient scheduling, front desk and switchboard. Supervise day-to-day billing operations, analyze and review each billing cycle to ensure accuracy and timeliness; prepare supporting monthly financial reports detailing billing status for CPA; maximize reimbursement from third-party payers. Also, monitor and manage use of clearing house and annual fee schedule; monitor account balances to identify and commence collections actions, and develop and maintain Billing Office standards, policies, workflows and procedures; implements strategies to continually improve the department's performance and ensure all billing activities are compliant with state, federal and industry standards and regulations. Will also serve as the HIPAA Privacy Officer. Starting at $70,000 annualStatus: ExemptBenefits: Center for Family Medicine offers a very competitive benefits package for full-time employees. This includes health, dental, vision, life and supplemental insurances; retirement plans, paid time off and other perks.Work/Life Balance: Center for Family Medicine recognizes that our staff have lives outside of work. This position will not have to work any nights, weekends, or holidays. With paid vacation time, employees are afforded the option to spend time enjoying activities outside of the office. We also plan company sponsored fun activities to ensure we get to know our co-workers on a more personal level. CFM also makes a commitment to support charity work and volunteer time!Skills/Qualifications: Must possess a comprehensive knowledge of revenue cycle functions and systems, as normally obtained through a Bachelor's degree in Business or Healthcare Administration or a related field. Two to four years of experience in a health care billing office in a supervisory role. Knowledge of CPT and ICD-10 codes and WRVU reporting. Good communication and listening skills required. Excellent computer skills. Attention to detail and good organization skills paramount. Effective critical thinking and problem-solving skills. Ability to analyze data and prepare related reports and summaries. #hc235643

Center for Family Medicine

Business Office Supervisor

Business Administration

Certified Public Accountant (CPA)

Communication Skills

Computer Skills

Credit and Collections

Data Analysis

Detail Oriented

Family Medicine

Fee Schedule

Financial Reporting

HIPAA (Health Insurance Portability and Accountability Act)

Healthcare Administration

Healthcare Reimbursement

Industry Standards

Medical Billing

Medical Treatment

Office Management

Operational Audit

Organizational Skills

Patient Care

Personal Care

Problem Solving Skills

Reporting Skills

Training/Teaching

OTHER

Print all paper claims from Vision/AdvantX, review claims for accuracy including modifiers, payers, claims addresses, and additional pertinent information included. Gather all supporting documentation such as operative notes, block reports, implant logs, etc. which MUST be attached with mailed claims.

Description: The Billing Assistant provides support to the billing & collections department in an effort to expedite case management. The billing assistant’s primary responsibility is to mail clean claims in a timely manner with the appropriate documentation to the payor responsible.  Responsibilities:<ul><li>Responsible for mailing paper claims for 30-35 Centers with an average monthly volume of 10K-15k.</li><li>Review Clearinghouse EDI Payer ID's and EMR system to see if claim can be sent electronically vs paper.</li><li>Print all paper claims from Vision/AdvantX, review claims for accuracy including modifiers, payers, claims addresses, and additional pertinent information included.</li><li>Ensure overall claim alignment and claim formatting, per payer guidelines.</li><li>Gather all supporting documentation such as operative notes, block reports, implant logs, etc. which MUST be attached with mailed claims.</li><li>Scan and upload claims & supporting documentation to the daily work folder and/or claims management system.</li><li>Notate in the EMR system with date claim was sent, mailing address, and supporting documentation mailed with claim.</li><li>Manage claim queues to ensure that cases are assigned to the correct team member for processing.</li><li>Collaborate as a team to mail overpayment letters and review returned mail twice a week.</li><li>Monitor communication and automation between various systems to ensure documents are getting to the coding team in a timely manner.</li><li>Coordinate with the billing team to update corrections that need to be addressed in greater detail are completed.</li><li>Complete additional duties as assigned.</li></ul> Required Skills Requirements:<ul><li>1-2 years’ experience in medical billing and/or accounts receivables preferably in an ASC setting.</li><li>Knowledge of CPT & ICD-10.</li><li>Strong attention to detail.</li><li>Ability to complete independent assignments with minimal supervision.</li><li>Basic knowledge of payers, EOB’s and claims processing.</li><li>Basic knowledge of billing software, vendors, and clearinghouses.</li><li>High School Diploma or equivalent.</li></ul> Required Experience

Strength in Numbers 

United Surgical Partners International (USPI) and Tenet have combined forces to create the nation’s largest ambulatory surgery provider. Our combined network of exceptional surgical and imaging facilities includes approximately 20 imaging centers, and over 265 short-stay surgical facilities. Together, our partnerships include 50 health systems and more than 4,000 physicians. Nationwide Experience 

Our partners deliver high quality ambulatory solutions in safe, efficient and caring USPI facilities in communities of every size across 29 states. Our physician partners are focused on providing quality patient care, in part because they are invested in their USPI facility. We provide the infrastructure and support they need to perform their best. This is one of the advantages of partnering with USPI. Quality Patient Services 

We share a vision with our physician and health system partners. Our goal is to provide the quality of healthcare services we would insist upon for our own families. Since our founding in 1998, this goal has helped us grow exponentially. Today, our strategic joint venture with Tenet establishes USPI as one of the nation's leading providers of ambulatory solutions. Operating Excellence 

Our size and experience in developing and operating ambulatory facilities and strategic vision allow our facilities to achieve both high patient satisfaction and solid financial results. Moreover, because we engage physicians in the governance and growth of the facility, we also achieve excellent clinical outcomes.

United Surgical Partners International Inc (USPI)

Billing Assistant

Accounts Receivable

Automation

Billing Software

Case Management

Claims Management

Claims Processing

Electronic Data Interchange (EDI)

Electronic Medical Records

Implants

Mail Processing

Time Management

silkroad ATS feed

FULL_TIME

Proficient with claim and coding tools such as Supercoder, Clinical Decision Support Tool, Current Procedural Terminology, Health Care Financing Administration Common Procedure Coding System, and American Dental coding. This role will serve as a SME and will collaborate with Claims leadership, Training, the Claims Content Specialist, and internal business partners to ensure procedures and training materials are accurate and complete.

We offer remote work opportunities (AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI & WY only).Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position.Veterans, Reservists, Guardsmen and military family members are encouraged to apply!Job Summary Provides Subject Matter Expert (SME) support to Claims Administration functional teams, by serving in a team lead role. Conducts retrospective review of medical/surgical claims and behavioral health claims for inpatient and outpatient services, as it relates to their assigned function (s). Applies clinical, coding, and processing knowledge to effectively perform assigned responsibilities. This role will serve as a SME and will collaborate with Claims leadership, Training, the Claims Content Specialist, and internal business partners to ensure procedures and training materials are accurate and complete. The Sr. Claims Reviewer will act as a Team Lead to Claims Reviewers by answering questions, performing on-the-job (OTJ) training, as needed. This position will also support the Supervisor, Claims Admin with daily inventory management workflows and the assignment of work to claims reviewers.Education & Experience Required: • High School Diploma or GED • U.S. Citizenship • Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background • investigation • 3 years claims review experience • Knowledgeable in medical, institutional, and behavioral health claims processes • Demonstrated ability to communicate effectively, both verbally and in writing • Intermediate proficiency in MS Office Suite Preferred: • Associated degree or higher in related field • Government claims experience • Claims coding certification or equivalent experience • Previous experience in a Team Lead or higher roleKey Responsibilities • Assists in the development of claims policies, procedures, training materials, and communications. • Serves as a Claims SME and collaborates in cross-functional forums, as assigned. • Conducts training and quality improvement activities within assigned functional team. • Effectively performs delegated tasks pertaining to daily inventory management workflows and routing of work. • Acts as a point of contact for claims-related inquiries and escalations, in the Claims Supervisor's absence. • Validates claim outcomes for accuracy and routes for adjustment, as necessary. • Conducts medical claims review using current claims processing guidelines and established clinical and program criteria. • Adheres to all desktop procedures for assigned function. • Identifies and appropriately communicates processing discrepancies or trends. • Reviews claim data for process improvements. • Communicates effectively and professionally with internal and external partners. • Consistently meets or exceeds individual performance expectations. • Identifies and reports potential quality or fraud issues per established procedures. • Performs other duties as assigned. • Regular and reliable attendance is required.Competencies Coaching / Training / Mentoring: Actively foster actions required for desired business outcomes through ongoing constructive feedback. Commitment to Task: Ability to conform to established policies and procedures; exhibit high motivation. Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate. Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications. Coping / Flexibility: Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach is required. High Intensity Environment: Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow. Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; detail-oriented. Team-Building / Team Player: Influence the actions and opinions of others in a positive direction and build group commitment. Technical Skills: Thorough knowledge of policies and procedures, Managed Care concepts and medical terminology. Proficient with claim and coding tools such as Supercoder, Clinical Decision Support Tool, Current Procedural Terminology, Health Care Financing Administration Common Procedure Coding System, and American Dental coding. Ability to meet or exceed production standards in compliance with contract. Working knowledge of behavioral health claims adjudication principles.Working Conditions Working Conditions: • Favorable working conditions in a climate-controlled office space • Must be available to cover any work shift • Works within an office environment with minimal travel required • Extensive computer work with prolonged sittingTriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $59,000 to $66,000 per year.Company Overview Taking Care of Our Nation's Heroes. It's Who We Are. It's What We Do. Do you have a passion for serving those who served? Join the TriWest Healthcare Alliance Team! We're On a Mission to Serve®! Our job is to make sure that America's heroes get connected to health care in the community. At TriWest Healthcare Alliance, we've proudly been on that important mission since 1996.BenefitsWe're more than just a health care company. We're passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes: <ul><li> Medical, Dental and Vision Coverage </li><li> Paid time off </li><li> 401(k) Retirement Savings Plan (with matching) </li><li> Short-term and long-term disability, basic life, and accidental death and dismemberment insurance </li><li> Tuition reimbursement </li><li> Paid volunteer time </li></ul>Equal Employment OpportunityTriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.

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TriWest Healthcare Alliance

Sr Claims Reviewer

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Medical CoderOphthalmology LTD

Business Office SupervisorCenter for Family Medicine

Billing AssistantUnited Surgical Partners International Inc (USPI)

Sr Claims ReviewerTriWest Healthcare Alliance

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