Billing and Coding Specialist

Billing And Coding SpecialistReports To: Director Of Revenue Cycle ManagementFLSA Status: Non-Exempt Personnel Supervised: NonePOSITION SUMMARY:Under general supervision the position is responsible for billing, coding, posting, assigning correct payer sources, submitting clean claims to insurances and follow up for on denial claims in order to maximize the revenue cycle through billing and coding expertise. Reviews, analyzes and assures the final diagnoses and procedures as stated by the practicing providers are valid and complete. Train and educate staff regarding proper billing and coding practices.MINIMAL QUALIFICATIONS:High School DiplomaMedical Coding Certificate – CPC or CCS certification requiredExcellent interpersonal skillsTwo years' experience using ICD coding, CPT, HCPS or equivalencyRESPONSIBILITIES AND PERFORMANCE EXPECTATIONS include, but are not limited to, the following:Assesses adequacy of health record documentation in order to support accurate, complete and specific assignment of modifiers, International Classification of Diseases (ICD), Current Procedural Terminology (CPT) and Health Common Procedural Coding (HCPC) codes to maximize reimbursement.Reviews record to ensure that the appropriate billing provider, required attachments, signatures and other relevant documentation to reflect treatment and services rendered are presence as required.Properly assigns and correct as warranted procedure, modifier and diagnosis codes supported by provider documentation. Appropriately queries provider for clarification or additional documentation needed for processing a clean claim.Generate and process claims from provider documentation to submit claims to appropriate payer in accordance with Medicare, Medicaid and Managed Care policies for proper reimbursement.Researches and ensures corrections are made on denied claims due to missing or incorrect information. Follows up with appropriate party as warranted regarding denials and payments.Review claims in holding status to process claims in a timely manner.Provides recommendations to Director of Revenue Cycle Management regarding accounts receivables, coding and billing practicesAttends seminars and in-services as required to remain current on coding issuesMaintains all mandatory in-servicesMaintains compliance standards in accordance with the Compliance policies and the Code of Conduct. Reports compliance problems appropriately.Determine the final diagnoses and procedures stated by the physician or other health care providers are valid and complete.Federal laws and regulations affecting coding requirementsPrinciples, practices and methods of current coding certificate requiredModern/Best office practicesKnowledge of billing practices required, FQHC preferredKnowledge of medical records, E H R requiredExtensive knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codesMust have good math skills and effective communication skillsPerform coding work requiring independent judgement with speed and accuracyExamining and verifying coding errors through auditsRequired in-servicesCommunicating clearly and concisely, orally and in writingConfidentialityAbility to use the computerAbility to work independently to accomplish assigned work in a timely mannerAbility to communicate with staff and the public, both in person and over the phone, in a tactful manner and under difficult situationsUnderstanding and carrying out verbal and written directionsFollow CFHC policies and proceduresWorks independently in the absence of supervisionPerforms other related duties, which may be inclusive, but not listed in the job descriptionBENEFITS:Competitive SalaryFederal Student Loan Forgiveness: PSLF – 10-year commitment, 120 loan payments and at the end of the commitment, the remaining loan is forgivenExcellent medical, dental, vision, and pharmacy benefitsEmployer Paid Long-Term Disability InsuranceEmployer Paid Life Insurance equivalent to 1x your annual salaryVoluntary Short-Term Disability, additional Life and Dependent Life Insurance are availableMalpractice InsurancePaid Time Off (PTO) – 4.4 weeks per year pro-ratedHolidays (9.5 paid holidays per year)Paid Birthday HolidayCME Reimbursement401k Retirement Plan after 1 year of service (w/matching contributions)Staff productivity is recognized and rewardedPHYSICAL REQUIREMENTS:Works under pressure and stress due to the diversity of our clinicsWork is performed indoors in a heated, air conditioned, well lighted and clean office settingRequires frequent lifting up to 20 pounds, and infrequent lifting up to 50 poundsRequires ability to distinguish letters, numbers and symbolsRequires normal range of visionRequires awareness of personal limitations and flexibilitySome emotional stress resulting from diversity and intensity of patients and staffRequires prolonged standing or sittingOccasional travel requiredAmerican with Disabilities Act (ADA) Statement: External and internal applicants, as well as position incumbents who become disabled, must be able to perform the essential job specific functions (listed within each job responsibility) either unaided or with the assistance of a reasonable accommodation to be determined by the organization on a case by case basis.