Coding/Billing Specialist

Pinehurst Medical Clinic (PMC)

PMC is a recognized healthcare provider in the communities of Moore County, Lee County, Cumberland County, Chatham County, and the surrounding six counties. Locally owned and managed, PMC offers a broad range of primary and specialty care services to the communities we serve. The physicians and healthcare team of professionals at PMC share a commitment to patient-centered care that is physician-led and utilizes the latest advances in medical technology. This combination of leading-edge medicine and deep compassion for the people we serve has been a hallmark of PMC since 1952. PMC consists of over 130 providers, approximately 750 employees, and 16 locations.

Position Summary

The Coding/Billing Specialist is responsible for the reviewing and processing of inpatient/outpatient hospital and office charges for physicians and APPs, along with billing charges through our Practice Management system, while checking for correctness and completeness prior to the charge document being processed for billing, insurance filing, and revenue reporting.

Essential Functions and Responsibilities

• Verifies and/or enters hospital registration and/or financial data efficiently and accurately through a computerized billing system.
• Responsible for maintaining up-to-date knowledge of coding and diagnostic procedures, as well as remaining current regarding federal legislative changes that affect outcome when provided with appropriate literature.
• Receives physician/APP charges from multiple locations.
• Reviews all charges for accuracy, asks questions when necessary, and understands the appropriate use of CPT and/or ICD-10 codes. Contacts appropriate personnel for clarification, etc.
• Assigns/reviews the CPT codes, diagnosis codes, and assign modifiers when applicable to charges.
• Responsible for reconciling all missing tickets for assigned services.
• Reconciles Daily/Monthly Logs that are generated by local hospitals.
• Responsible for working claim scrub queues with a multitude of accounts and charges to correct bundling guidelines and NCD/LCD coverage policies, as well as working denials from Insurance companies.
• Responsible for filing appeals on denied claims or providing additional information to third party payers to facilitate reimbursement.
• Responsible for obtaining prior authorization for scheduled procedures.
• Responsible for telephone and written inquiries regarding precertification and insurance related matters.
• Assists with denial resolutions, with direct participation with management and other staff members.
• Responsible for working missing referral reports.
• Prepares telephone, written, or on-line pre-certification requests providing detailed explanation.
• Verifying patient benefits calling patients with estimated OP cost for Infusion Drugs. Position is also responsible for enrolling some patients into Copay Plans.
• Other duties as assigned.

Qualifications

Education (Including Licenses and Certifications): High school diploma or general education degree (GED); or one year related experience and/or training; or equivalent combination of education and experience.

Experience: Previous experience with outpatient billing to include CPT, ICD-10 coding. Detail oriented with strong financial emphasis. Medical Office experience.

Shift: Day Shift (Monday through Friday) no weekends or holidays Pay Type: Hourly (Non-Exempt) The Pinehurst Medical Clinic is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations and provides equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law

(Monday through Friday) no weekends or holidays 40 hours per week