• Validate and determine appropriate coding levels by obtaining and reviewing clinical documentation.• Compare and review charges to clinical documentation to ensure that all charges for procedures have been accurately documented and captured.• Assist with insurance verification and authorizations, if required, for visits and treatment using portals such Epaces, Availity & Navinet.• Trained team on how to monitor Medicaid recertification time frames for each active Medicaid member and utilization threshold.• Ensure that documentation supports charges to prevent denials/underpayments; Assist with implementation of documentation.• Review coding related information to clinical staff, including CPT and ICD-10 code changes, medical necessity policies, coding/billing information regarding new procedures.• Knowledge of Epic Care, Eagle, Cerner, Passport both in the office and working remote from home.

• Obtaining authorizations for in-office & out-patient procedures, medications, radiology services, and physical therapy. • Verifying insurance eligibility live via phone and/or website portal for the following specialty visit: Neurology, Gastroenterology, HIV Specialist, Family Practice and tests such as EMG, NCV, Ansar, and Ultrasounds.• Provide insurance information such as copayments, coinsurances, deductibles, provider participation with insurance, and change of primary care physician to receptionist.• Fill out C-4, C-4.2, & C-4.3 according to providers’ notes. Send out to insurance carrier for payment and Worker’s Compensation Board for proof; also complete MG-2 and MG-2.1 forms for a variance request not within the guidelines, as well as C-4 Authorizations for special services. • Retrieving medical records/notes for attorneys and adjusters for Worker’s Comp. and No-fault cases.

• Verified eligibility for insurance; Answered phones, screen callers, relay messages, and greet visitors.• Registered new patients and updated patient demographics by collecting patient detailed information.• Entering daily charges for office visits, processing electronic and paper claims, posting co-payments & insurance payments.