Medical Coding Billing Specialist

Job Description

Job Description

The Medical Billing and Coding Specialist is a key position in the Revenue Cycle that manages the claim process, including accurate and timely claim creation, follow-up and correspondence with providers, insurance inquiries/correspondence. This position will assist in the clarification and development of process improvements and inquires, assure payment related to patient services from all sources are recorded and reconciled timely to maximize revenues. Other important duties include coding, credentialing, and resolving claim issues and denials.

Essential Duties and Responsibilities

The essential functions include, but are not limited to the following:

• Evaluate medical record documentation and coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflects and supports visits and to ensure that data complies with legal standards and guidelines.
• Interprets medical information such as diseases or symptoms and diagnostic descriptions and procedures to accurately assign and sequence the correct codes.
• Reviews all claims for completeness and accuracy before submission to minimize claim denials
• Evaluates records and prepares reports on topics such as the number of denied claims or documentation or coding issues for review by management and/or committees
• Makes recommendations for changes in policies and procedures; updates procedures to maintain standards for correct coding to minimize the risk of fraud and abuse, and to optimize revenue recovery.
• Provides technical guidance to physicians and other staff in identifying and resolving issues or errors such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, and/or codes that do not conform to coding principles/guidelines
• Reads bulletins, newsletters, and other periodicals to stay abreast of issues, trends, and changes in laws and regulations governing medical record coding and documentation
• Educates and advises staff on proper code selection, documentation, procedures, and requirements
• Identifies training needs and conducts training to staff as needed to improve skills in the collection and coding of quality health data
• Submits claims to a variety of payment sources, including Medicaid and Medicare, and other third-party payers. Prepares, reviews, and transmits claims using EPIC, including electronic and paper claim processing.
• Maintains communication with patients and third-party payers until accounts are paid or referred to another appropriate agency for further collection activity.
• Posts payments from both patients and third-party payers to patient accounts
• Verifies insurance reimbursements for accuracy and compliance with contract discounts
• Contacting insurance companies regarding any discrepancies and or denials
• Identifies and coordinates the billing of secondary or tertiary insurances
• Coordinates collection process, to include any projects with a collection agency and financial counselor
• Manages daily statement process, including reviewing statements before sending and fielding any patient inquiries
• Coordinates and administers policy and procedure for payment plans and auto-pay patients
• Collaborates and works with front desk staff to ensure appropriate collection of self-pay, copay, and balance due
• Handles patient inquiries as well as questions from other staff and insurance companies
• Identifies and resolves any patient billing related problems, denials, and insurance company follow up
• Oversee patient accounts and process refunds as necessary
• Audits current procedures to monitor and improve the efficiency of the revenue cycle by making recommendations for process improvement (billing and collections operations).
• Ensures that the activities of the billing and collections operations are conducted in a manner that is consistent with overall department protocol, and compliant with Federal, State, and payer regulations, guidelines, and requirements.
• Analyzes trends impacting charges, coding, collection, and accounts receivable and makes recommendations for improvement.
• Understands and remains updated with current medical accounts receivable and billing regulations and compliance requirements.
• Maintains working knowledge of all health information management issues such as HIPAA and all health regulations.
• Coordinates provider enrollments in all commercial, state, and federal insurance programs with Management and correspond to payer requests for updates to information
• Provide data and support to Management as needed  

Minimum Qualifications (Knowledge, Skills, and Abilities) 

Education and Experience:

• Two (2) years Medical Insurance/Healthcare Billing in a medical practice or health system, with a deep understanding of medical billing rules and regulations preferred. A combination of education and experience will be considered.
• Associates degree in accounting, business, finance, medical billing, or related field, preferred. 
• Coding Certification preferred.
• Experience working with a variety of medical payers including Medicare, Medicaid, and commercial insurance preferred
• Experience working with EPIC preferred
• Working knowledge of CPT, ICD-9 & ICD-10, ANSI coding systems; coding certification preferred, but not required

Knowledge

• Healthcare Billing -  Must possess a thorough understanding of medical billing and coding, insurance verification and authorization, collections, payment posting, revenue cycle, and third-party payers.
• Customer and Personal Service - Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
• English Language - Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar. Ability to read, write and speak the English language.
• Administrative: Knowledge of administrative and office procedures and systems such as word processing, managing files and records, designing forms, and workplace terminology.
• Training : Knowledge of principles and methods for training, teaching and instruction for individuals and groups, and the measurement of training effects.
• HIPAA – Knowledge of HIPAA regulations, clinic policy and the importance of maintaining patient confidentiality, including abiding by the minimum necessary access and disclosure.  

Basic Skills

• Active Learning- Understanding the implications of new information for both current and future problem-solving and decision-making.
• Active Listening- Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
• Critical Thinking- Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.
• Communication – Communication is essential to this position. Communication will occur between all departments and positions to ensure proper patient service. This position requires the ability to understand written sentences and paragraphs in work-related documents, the ability to talk to others to convey information effectively and the ability to effectively in writing as appropriate for the needs of the audience.
• Interpersonal skills – including coordination, instructing and social perceptiveness.
• Time Management skills- Managing one's own time and the time of others.

Technical Skills

• Troubleshooting- Determining causes of operating errors and deciding what to do about it.
• Must be able to work standard office equipment; computers, fax machines, copiers, printers, telephones, etc.

Work Context

Communication

• This position will require communication between all staff and departments. 

Role Relationships

• This position plays an integral role in assisting with staff morale, relationship building and collaborative team projects. 

Responsibility for Others

• This position does not have any direct reports.

Work Setting 

• Climate controlled office. 

Work Attire

• This position requires business casual attire with professional footwear
• A uniform jacket is provided 
• A name tag is provided and required to be worn during working hours

Physical Demands and Work Environment 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions.

• This position may require a high level of independent decision-making regarding billing related tasks. This position requires communication with team members to finalize decisions that could impact the team and/or practice. 
• Role will have periods of fast paced work as well as periods of slower paced work

• Ability to read and view fine print
• Ability to reach, stoop, and bend to retrieve files and supplies to complete tasks
• Must be able to lift, carry or otherwise move and position objects weighing 10-20lbs at times
• Continuous use of the telephone to verbally speak to insurance companies and patients
• Must be able to handle high-stress situations with multiple tasks having similar deadlines
• Prolonged periods of sitting at a desk and viewing/using a computer
• Prolonged repetitive movements of hands, fingers, and arms for typing and/or writing during work shift

Tools and Technology

• The following tools and technology may be required as part of this position.
• Computers
• Scanners/Copy Machines
• Calendar and scheduling software
• Electronic mail software (including Outlook)
• Medical software - EPIC
• Microsoft Office suite software

Note

This job description in no way states or implies that these are the only duties to be performed by the employee(s) of this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the employee(s) will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an at will relationship.