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in Miami, FL

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About this job

We have a full-time opening for a Medical Billing Clerk.

Must be able to work various shifts per week.

  • Must have 1 or more years experience.
  • Must have a high school diploma or equivalent.
  • Be authorized to work in the United States.
  • Must have reliable transportation.
  • Background check required.

Requirements

SUBJECT
The contractor will provide medical billing verification of medical invoices received at the Federal Correctional Institute, hereinafter referred to as the FCI, located in Miami, Florida.
PLACE OF PERFORMANCE
The FCI, Health Services Unit, located at 15801 SW 137 Ave., Miami, FL 33177
SCHEDULE
The work schedule will normally consist of 30 sessions per week, with a session being defined as one-hour length, six (6) sessions per day, five days a week, Monday-Friday, 8:00 am to 2:30 pm, excluding federal holidays. The schedule will include a half hour unpaid lunch break. The schedule is subject to change depending on the needs of the institution. The total number of hours worked will not exceed 30 hours per week.
DUTIES
* Utilizing Medicare Part A and Part B payment regulations and payment recommendations from a third party adjudicator, the contractor shall verify that invoices for the provision of medical care to inmates which have been determined to have been properly coded are also billed appropriately in accordance with the contracted terms and conditions of the contract under which the medical services were provided. If the invoice presented for payment is determined to have been billed appropriately, the contractor shall indicate by signature on the invoice that a billing review has identified no inconsistencies. If the invoice presented for payment cannot be determined to have been billed appropriately, the invoice shall be returned to the COR with a written determination detailing why the invoice cannot be certified as correct.
* Utilizing contracted rates provided by the Government, the contractor shall verify that invoices for services performed at the FCI are accurately billed based upon the inclusion of approval/verified time sheets, the application of correct unit prices to the number of hours billed, and the overall total calculation. The candidate will be contacting the entities providing services to ensure that all relevant medical information is added to the medical record system in order to ensure completeness and accuracy of the patient's medical record.
* Utilizing knowledge of Medicare coding and billing standards and procedures, contractor shall investigate all inconsistencies in invoices identified by third party adjudicator. If invoices have been determined as coded and billed correctly, the contractor shall contact the third party adjudicator to update their records and indicate by signature on the invoice that a billing review has identified no inconsistencies. If invoices have been determined as coded and billed incorrectly, contractor shall return the invoice to the COR with a written determination detailing why the invoice cannot be certified as correct and then notify the medical contractor of inconsistencies per Medicare coding and billing standards and procedures. If the medical contractor disagrees with inconsistency notifications, contractor shall review additional documentation from medical contractor and forward to necessary BOP staff for further payment direction. In accordance with the Privacy Act of 1974 and ensure security of all information and data. Any request for information relating to an inmate's medical care shall be referred to the COR for proper disposition.
* The contractor shall have access to the following automated resources to perform the tasks identified in this Statement of Work: BEMR (Bureau Electronic Medical Record), IPPS PC Pricer, Microsoft Word, Microsoft Excel, SENTRY and Internet Access. The contractor shall have online access to medical coding, ICD-9/CPT codes. The contractor shall verify invoices for services billed under the Medicare Outpatient Prospective Payment System through manual calculations as needed and comparison to payment recommendation from third party adjudicator. Duties will also include, but are not limited to, general office administration functions such as: filing, composing memoranda, maintaining suspense files, data entry, data retrieval, and electronic compiling of data and any clerical duties assigned.
SPECIAL QUALIFICATIONS REQUIRED:
* The contractor shall have experience in Medicare principles, strong computer skills (Microsoft Office, Excel Applications), experience with medical coding, medical procedures, and strong organizational skills. \
* The contractor must be proficient with telephone communications and have excellent organizational skills.
* The contractor must be bilingual English/Spanish.
The contractor shall have at a minimum one (1) year of experience in Medicare principles and a certificate in one of the following:
o Registered Health Information Administration
o (RHA) Registered Health Information Technician
o (RHIT) Certified Coding Specialist (CCS)
o Certified Coding Assistant (CCA) Certified
o Professional Coder (CPC)
o Certified Medical Billing and Coding Specialist