Billing & Coding Specialist

Job Description

Job Description

Our Core Values:
The culture at Prism Health North Texas is built on our shared Core Values. We make hiring, firing, promotion and performance review decisions based on these values and behaviors, so it is important that you also share these Core Values:

• We are solution seekers.
• We have a can-do attitude .
• We are mission driven .
• We care about people .

General Description:
The Billing & Coding Specialist performs charge capture, coding, billing and reimbursement operations, education on behalf of a multi-specialty, multi-site practice providing medical, dental, and behavioral health services.  This role is responsible for ensuring accuracy and timeliness in all aspects of the claim submission process.  Responsibilities Job Responsibilities
Specific Responsibilities of the Job:

• Charge capture – ensure all completed visits for insured and grant-eligible medical, behavioral health, and dental patients are translated into claims or invoices.
• Review coding of each claim/invoice before submission to ensure that coding is accurate and complete, billing guidelines are followed, and coding is consistent with medical record documentation of services provided. Recognize when to query provider or clinic staff for further information.
• Scrub and submit claims via clearinghouse and/or outsourced billing service.  Monitor, research, correct, and resubmit rejected claims.  Address payer edits and other edits/actions as assigned.
• Research and address denials, prepare appeals.  Identify and communicate root cause of denials; propose solutions and additional training to minimize denials.
• Identify, research, and address payments inconsistent with contractual terms/rates.
• Lead, evaluate and maintain processes and workflow to ensure efficient and accurate coding and billing. Recommend improvements as noted.  Maintain up-to-date standard operating procedures and documentation.
• Develop and lead coding and billing compliance reviews and documentation education for providers, staff, and leadership.
• Participate in new EHR implementation and billing-related troubleshooting.
• Monitor billing software dashboards and review accounts receivable with clinic, finance, and other senior leaders.
• Work effectively with clinic management, providers, clinic staff, third party billing services, finance and accounting to optimize billing and coding activities.
• Model the highest level of service and professionalism for both internal and external customers. Communicates clearly and accurately with patients, staff, and providers.
• Special projects and other duties as assigned.

Required Skills Required Knowledge, Skills and Abilities:

• Medical and/or Dental Coding Certification required.
• Demonstrated experience in ambulatory practice Procedure, E&M, Medical, Behavioral Health, and/or Dental Coding and Billing practices.
• Demonstrated knowledge of medical, behavioral health, and/or dental professional billing; medical and/or dental terminology; dental coding and/or ICD-10, CPT, and HCPCS coding.
• Ability to work in MS Word, Excel, PowerPoint, and Electronic Health Records.
• Strong written and oral communication skills.
• Strong technical and business acumen.

Education and Experience:

• High School Diploma or equivalent required. Associate or Bachelor’s degree preferred.
• 3 years of experience in medical, behavioral health, and/or dental coding and billing. Experience working with third-party billing service preferred.
• Work experience in a Federally Qualified Health Center (FQHC) or FQHC look-alike a plus.
• Work experience with Ryan White and/or Title V funding a plus.