Billing and Coding Analyst - Surgical Subspecialty Clinic

THE POSITION:

Under general direction this position is responsible for providing billing and coding support within the Ambulatory Care Clinic System. The clinic areas of specialization include ENT, plastic reconstruction, neurology, and urology. Examples Of Duties: Reviews electronic medical records initiated by a health care provider and ensures accuracy of diagnosis, procedure codes, and modifiers in accordance with Federal and State regulations in compliance with billing and coding guidelines. Effectively monitors assigned work queues and reviews claim errors, ensuring timely and accurate resolution of accounts. Review, analyze and validate medical records to ensure completeness and accuracy of code selections while identifying educational opportunities. Prepares educational materials to communicate with providers when identifying gaps in clinical documentation for the selection of appropriate diagnosis, procedure and modifiers. Performs edit checks on data entered prior to transmittal and corrects errors as indicated by using our standard reporting such as discharged, not final billed (DNFB) correction required, late charges, suspended charges, encounters with and without charges, past due arrival or other specialized reporting including eligibility. Ensures accurately coded data is integrated properly into the billing process timely while developing efficient workflows and streamlining reimbursement. Collaborates with the billing staff to identify trends and improvement opportunities. Conducts provider and staff training and ongoing education on billing guidelines and audits the work of non‑facility coders. Remains current with regulatory guidelines for billing and coding including health plans and coding updates. Reviews and analyzes denials, rejected claims, registration errors, missing authorizations and compiles training materials to educate the support staff for denial prevention and unnecessary claims rework. May be assigned multiple locations to ensure accurate and timely completion of assigned reporting and billing activities. Reviews application forms, supporting documentation, registration and billing for compliance with the sliding fee discount program. Participates in audit resolution, implementation and oversight of corrective action activities. Performs other related duties as assigned.

EDUCATION, TRAINING, AND EXPERIENCE:

Any combination of education and experience which has led to the acquisition of the required knowledge, skills, and abilities. The required knowledge, skills, and abilities can typically be obtained by: Seven (7) years of hands‑on working knowledge and experience performing professional medical coding and/or billing duties in a medical system comparable to the Ventura County Medical Center or an outpatient clinic providing high volume surgical specialty services similar to the Ventura County Ambulatory Care clinics.

NECESSARY SPECIAL REQUIREMENTS:

Previous paid, professional billing and coding experience working in a surgical environment. Must possess and maintain at least one of the following: Certified Coding Specialist (CCS) Certified Professional Coder (CPC) as credentialed by the American Academy of Professional Coders (AAPC) Certified Coding Specialist‑Physician (CCS‑P) as credentialed by the American Health Information Management Association (AHIMA). #J-18808-Ljbffr Salem Health Hospitals & Clinics