Medical Billing and Coding Specialist

Job Description

• Title:Medical Billing Specialist
• Department: Billing
• Reports To: Practice Administrator
• Supervises: Position has no supervisory responsibilities
• Education:High School Diploma or GED with relevant work experience required. A college degree preferred.
• Certified Professional Coder
• This is not a remote position, but it does have the possibility of becoming Hybrid/Remote.
• Good working knowledge of medical terminology and anatomy required

Experience:

Minimum of 5 years of Medical Billing/Revenue Cycle experience required, preferably in an OBGYN setting

• Electronic filing of claims and reporting required. Athena experience helpful.
• Typical Physical Demands:Ability to use a wide array of office equipment including, but not limited to a PC, copier, fax, multi-line telephone, etc
• Combination of sitting, standing, bending, light lifting, and walking
• Requires a full range of body motion including manual and finger dexterity and hand-eye coordination
• Requires corrected vision and hearing to a normal range
• Requires the ability to manage stressful situations
• Occasional stress from vary demands, minimized by employee’s own organizational skills and multi-tasking abilities.
• Job Summary: Responsible for all facets of Medical Billing and accounts receivable management including charge entry, payment posting, customer service and follow-up in accordance with practice protocol with an emphasis on maximizing patient satisfaction and profitability. Responsible for reviewing the patient demographic information in Athena EMR at the time of charge entry to ensure accuracy and to provide feedback to the front office staff regarding patient registration. Responsible for reviewing the providers’ coding at the time of charge entry to ensure accuracy, timely payments, and to maximize revenue. Responsible for submitting insurance claims and appeals electronically and on paper, as needed.
• Special Characteristics:

This position requires a comprehensive understanding of accounts receivable management in a healthcare setting. This positon requires strong working knowledge of managed care plans, insurance carriers, referrals, and pre-certification procedures. Also required is a strong working knowledge of CPT, ICD9, ICD10, HCPCS, modifiers, coding and documentation guidelines. Strong customer service, organizational and communication skills are essential to this position. In addition, strict adherence to write off policies, refund policies and other accounts receivable policies is required. This position requires an ability to prioritize multiple tasks simultaneously in an occasionally stressful environment. Also, required are general computer skills, typing skills and a working knowledge of Medicare Compliance and HIPAA.

• Essential Duties:Perform initial charge review to determine appropriate ICD10 and CPT codes used to report provider services to third party payers
• Interprets progress notes, operative reports, discharge summaries, and charge documents to determine services provided and accurately assign CPT and ICD10 coding to services
• Input all charges related to the assigned physician’s professional services into Athena including office and hospital charges in accordance with practice protocol with an emphasis on accuracy to ensure timely reimbursement and maximum patient satisfaction and profitability.
• Provides constructive feedback to providers regarding coding practices to ensure accuracy and proper coding.
• Responsible for reviewing patient logs and other report of clinical activity to ensure billing is captured for all patients.
• Monitors and follows up to ensure all services that can be billed are captured and coded for billing.
• Reviews all provider documentation to ensure compliance with third party and regulatory guidelines
• Works in conjunction with staff to answer all inquiries regarding coding and billing for providers’ services
• Post all credit and debit adjustments to patient accounts
• Provide customer service on the telephone, through portal and/or email communications, and in the office for all patients and authorized representatives regarding patient accounts in accordance with practice protocol. Patient calls regarding accounts receivable should be returned within 2 business days to ensure maximum patient satisfaction.
• Verify all demographic and insurance information in patient registration of Athena to ensure accuracy, provide constructive feedback to front office staff and to ensure timely reimbursement.
• Follow-up on all outstanding insurance claims at 60 days from the date of service in accordance with practice protocol with an emphasis on maximizing patient satisfaction and practice profitability.
• Follow-up on all outstanding patient account balances at 90 days from the date of service in accordance with practice protocol with an emphasis on maximizing patient satisfaction and practice profitability using AR Aging Reports.
• Follow-up on all returned claims, correspondence, denials, account reconciliations, and rebills in a timely manner to achieve maximum reimbursement.
• Provide information pertaining to billing, coding, managed care networks, insurance carriers, and reimbursement to providers, managers, and subordinates.
• Process refunds to insurance and patients in accordance with practice protocol.
• Maintain information regarding coding, insurance carriers, and managed care networks in an organized and easy to reference format.
• Maintain an organized, efficient and professional work environment.
• Adhere to all practice policies related to OSHA, HIPAA and Medicare Compliance
• Other duties as assigned.
• Skills:

The jobholder must demonstrate current competencies applicable to the job position.

• Requires excellent written and verbal communication skills and strong customer service skills.
• Requires strong basic mathematical skills.
• Requires an extensive working knowledge of managed care networks and insurance carriers.
• Requires and extensive working knowledge of accounts receivable functions including CPT and ICD10 coding
• Requires proficiency in general office automation including operation of fax machines, copy machines, adding machines, postage machines, and multi-line phone system.
• Requires proficiency in working with a PC, the internet, MS Windows and Office, and EMR.
• Requires a good understanding of the current Medicare Compliance and HIPAA regulations
• Requires a high degree of organization and prioritization.

Job Type: Full-time

Pay: $19.35 - $23.30 per hour

Expected hours: 35 – 40 per week

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Work setting:

• Clinic
• Hybrid work
• Office
• Private practice

Work Location: Hybrid remote in Cary, NC 27518