Medical Billing/ Coding Specialist

Position Description

The Medical Billing/Coding Specialist is responsible for billing and analyzing procedures and modifiers to troubleshoot and resolve billing issues, rejections, denials, and appeals. Works with Medicaid and any other governmental or commercial insurance carriers to resolve claim errors and responds to billing questions from internal and external sources. Reviews billing charges and other data for accuracy and potential reimbursement enhancement. Run, review, and summarize reports for billing and reimbursement. Remain up to date on billing guidelines. Works collaboratively with clinical and health information management staff as well as with Finance staff regarding billing revisions in the electronic billing system. Works as part of a cross-functional team to ensure all services provided are billed in a timely and accurate manner. Handles sensitive and confidential information appropriately and in compliance with HIPAA regulations.

Analysis/Review Duties

• Analyzes billing procedures and modifiers to resolve billing issues, rejections, denials, and appeals
• Obtains authorizations as needed (per insurance requirements)
• Works with Medicaid and all other governmental and commercial insurance carriers to resolve claim errors.
• Reviews billing charges and other data for accuracy and potential reimbursement enhancement.
• Obtains from applicable providers, clinics, and support staff complete diagnosis information to ensure proper assignment of codes.
• Responds to questions from staff, insurance carriers, and clients.
• Run, review, and summarize reports for billing, reimbursement, and accounts receivable.
• Works collaboratively with clinical and health information systems staff as well as with Projects & Business Technology staff regarding billing/coding revisions in the electronic billing system.
• Works as part of a cross-functional team to ensure all services provided are coded and billed in a timely and accurate manner.
• Provide feedback on operational improvements to enhance the efficiency of charge capture to reduce denials and optimize overall reimbursement.
• Develop, implement, and manage processes to reconcile billed charges to scheduled visits.
• Provide applicable data related to Key Performance Indicators (KPI).

Requirements

Education Requirements:

• High School Diploma or equivalent

Experience Requirements:

• One (1) years overall coding and billing experience with the following:
• One (1) year of experience in medical insurance billing and coding denial resolution.
• Knowledge and expertise regarding the assignment of correct Healthcare Common Procedure Coding System (HCPCS) codes and ICD-10 codes are desired.
• Working knowledge in analyzing contract requirements and governmental regulations relating to medical billing.
• Experience with analyzing and implementing effective internal controls.
• Working knowledge of HIPAA regulations and impact on practice operations.

Computer Proficiency:

• Must be proficient in Microsoft Office applications.
• Understanding of computer networks, operations, and Practice Management applications.

Knowledge, Skills, and Abilities:

• Must have excellent and effective communication skills, both oral and written.
• Understanding of medical insurance billing procedures, third-party reimbursement, and medical terminology.
• Solid knowledge of medical billing compliance rules, including those related to third-party intermediaries.
• Must be able to provide quality customer service.
• Must be able to work with management and staff at all levels.
• Ability to analyze and interpret detailed reports and summarize findings.
• Ability to organize and prioritize workloads to manage multiple tasks and meet deadlines.

Preferences

Education Preferred:

• Associates degree in health records technology, medical coding and/or billing, Public Health or related health information emphasis.

Licenses/Certifications Preferred:

• Certification as a Professional Coder (CPC)
• Certification as a Professional Biller (CPB)

Experience Preferred:

• One (1) year of Outpatient Billing and coding knowledge
• One (1) year of billing experience and coding denial resolution.

Job Type: Full-time

Pay: $12.00 - $16.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off

Schedule:

• 8 hour shift
• Monday to Friday

Experience:

• medical billing: 1 year (Preferred)

Work Location: In person