Specialty Billing & Coding Specialist
MedCentris
This is a remote role
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.
MedCentris is an EEO employer - M/F/Vets/Disabled