Specialty Billing & Coding Specialist

Definition and Role

The Specialty Billing and Coding Specialist works directly with the Director of Health Informatics to ensure the coding and abstracting of documentation are conducted in an accurate, comprehensive, and efficient manner. The Remote Billing and Specialist must be experienced in all aspects of both diagnostic and procedural medical coding and billing. This role reports to the Assistant Director Revenue Cycle – Coding & Medical Records up to the Director of Revenue Cycle.

Job Responsibilities and Duties

• Verify and enter patient demographic and insurance information into practice management software.
  
• Abstract information from medical record and assign appropriate codes, as necessary.
  
• Work flexed hours to ensure claims are submitted in a timely manner.
  
• Strive to complete your daily claims per hour goal for both coding & denials management.
  
• Prepare and submit claims to third party insurance carriers either electronically or by hard copy billing.
  
• Researches an analyzes denial data & coordinates denial recovery responsibilities.
  
• Understand insurance benefits including copays, deductibles, and coinsurance.
  
• Interacts with internal providers and external facilities to procure documentation for coding claims, as necessary.
  
• Research rejected and denied claims.
  
• Understand and apply medical terminology, ICD-10, CPT-4, & HCPCS coding guidelines & payer rules.
  
• Work with physicians and others to ensure complete and accurate information and optimal reimbursement based on coding.
  
• General sorting, filing, scanning, and faxing of documents.
  
• Identifies analyzes and researches frequent root causes of denials and develops corrective action plans for resolution of denials.
  
• Read, interpret, and enter information into the facility’s database using medical coding protocol to produce a statement or claim.
  
• Conduct various audits and data reports for supervisor.
  
• Performs other related duties as assigned.

Qualifications & Skills

• Any combination of training, education and/or experience which provide the knowledge, skills and abilities and required conditions of employment listed below is qualifying. An example of a way these requirements might be required is
  
• A minimum of a bachelor’s degree in a related field is preferred, or experience in Laboratory and/or Hyperbaric Oxygen medical billing/coding with an emphasis in clinic/hospital-based coding & billing.
  
• Advanced principles and practices of medical terminology, anatomy, and physiology, as well as the states, sequence, progression, and description of diseases as they apply to medical record coding and abstraction.
  
• Reviewing medical procedures as documented by nurse practitioners and doctors.
  
• Elements of ICD-10-CM, CPT, and HCPS Level II Coding systems.
  
• Knowledge of standard MS Office products.
  
• Proper phone etiquette which is necessary since phone conversations with patients and insurance carriers will be frequent.
  
• The operation of standard office equipment; standard business computer hardware and software.
  
• The business and professional relationships and ethics involved among hospitals, physicians, and patients.
  
• Plan and organize routine medical records technical and clerical work.
  
• Able to translate medical procedures into codes that can be translated by payers, other medical coders, and other medical facilities.
  
• Communicate clearly and concisely, both orally and in writing.
  
• Provide excellent public relations and courteous customer service; establish and maintain cooperative working relationships with others including physicians, nurses, administrators, managers, vendors, contractors, and other health care industry personnel.
  
• Ability to work well under pressure and adapt to changes in project priorities.
  
• Must be able to accommodate a flexible work schedule.

Physical Requirements

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  
• While performing this job the employee is frequently required to sit, talk, and hear.
  
• The employee is occasionally required to walk, use hands and fingers to feel, handle, or operate objects, tools, or controls, and reach with hands and arms.
  
• The employee must occasionally lift and/or move objects weighing up to 25 pounds.
  
• Specific vision abilities required by this job include close vision and the ability to adjust and focus.