What are the responsibilities and job description for the Hospital Coding and Billing Specialist position at Catholic Care Center?
Hospital Coding and Billing Specialist
Position Summary
Under the direction of the Business Office Manager, this position is responsible for assigning and sequencing medical codes for diagnoses and procedures in accordance with established coding guidelines. This role requires adherence to ethical coding standards and involves reviewing provider documentation to ensure accurate coding for reimbursement and data purposes. This Specialist will also serve as a subject matter expert with the organization and participate in audits and documentation improvement reviews.
This position is also responsible for maintaining accounts receivables related to Third Party Insurances, which includes timely and accurate billing for services provided, collection of accounts receivable, claims submission to all payers and month-end processing.
CODING PRINCIPAL DUTIES AND RESPONSIBILITIES
- Assigns codes using ICD, CPT, and HCPCS.
- Sequences diagnoses and procedure codes according to coding guidelines.
- Maintains confidentiality of patient records and reports non-compliance.
- Reviews provider documentation to support assigned codes.
- Follows up on inaccurate documentation for clarification.
- Adheres to ethical coding standards and official guidelines.
- Meets departmental quality and production standards.
- Acts as a subject matter expert for coding leaders and peers.
- Participates in payer audits as a resource for coding-related inquiries.
- Processes coding claim appeals and rejections.
BILLER PRINCIPAL DUTIES AND RESPONSIBILITIES
- Responsible for accurate and timely billing of Third Party Insurance Claims and A/R follow-up as assigned, including, but not limited to:
- Medicare A & B
- Managed Care/Private Insurance
- Medicaid/PACE
- Third Party Coinsurance
- Maintain documentation to support third party claims submission and collections in accordance with defined policies.
- Manage A/R collections through claims submission, adjustments, phone calls, and appeals as needed on assigned communities, to meet and/or reduce day’s sales outstanding goals as established by the Director of Finance.
- Maintain A/R notes in the billing software with all outstanding A/R balances reviewed at minimum every 30 days.
- Prepare documentation/collection notes for monthly accounts receivable reviews with Business Office Manager and Director of Finance.
- Identify, document, and communicate best practices and process improvement opportunities to Business Office Manager.
- Assist with cash posting as needed.
- Provide back-up and cross-training to other associates.
- Remain up to date on CMS regulations and policies, as well as federal and state regulations and policies related to healthcare, long term care facilities, and insurance.
- Prepare documentation for approval of A/R adjustments including, but not limited to:
- Contractual Adjustments
- Charity Adjustments
- Bad Debt Write Offs
- Administrative Adjustments
- Insurance Refunds
- Maintain the monthly Medicare Bad Debt log for dual eligible and other accounts, with supporting documentation, to be approved for write off by the Business Office Manager, Director of Finance, and Executive Director.
- Maintain ongoing metrics for the Business Office Manager and the Director of Finance to provide continual self-assessment of performance and identification of process improvement opportunities.
- Attend and actively participate in trainings and meetings.
- Other duties as assigned.
Management Responsibilities
- N/A
Education and/or Experience
- Professional Coder (CPC) certification or equivalent certification required
- Advanced training in Geriatric Behavioral Health coding from an accredited program preferred
- Minimum of 2 years of professional coding experience
- Minimum of 3 years of Accounts Receivable processing experience.
- Education or experience in third party reimbursement billing, collections, and compliance assurance for skilled nursing facilities including Medicare, Medicaid, Managed Care and Coinsurance preferred.
- Ability to define problems, analyze data, establish facts, and draw valid conclusions.
- Ability to read and interpret documents such as CMS regulations, Managed Care contracts and other instructions and procedure manuals.
- Ability to speak effectively before administrators, residents or employees.
- 3-5 years administrative and clerical experience preferred.
Certificates, Licenses, Registrations
- N/A
KNOWLEDGE, SKILLS AND ABILITIES
- Working knowledge of financial practices.
- Must be able to read, write and communicate in English.
- Must possess strong collaborative, interpersonal, organizational, multi-tasking, verbal and written communication skills, and a desire to create a high-performance, effective team that can produce consistent, demonstrated results.
- Must demonstrate on an ongoing basis the ability to develop and maintain good working relationships with co-workers and ministry leadership.
- Competencies needed for this position include strong interpersonal relationship skills, detail oriented, work in collaboration with others, demonstrate a high degree of integrity and personal commitment, possess strong analytical skills, be able to work independently and manage multiple deliverables at the same time.
- Ability to function in a matrix environment and demonstrate a passion to succeed be self- motivated, dependable, committed, and a willingness to see a project through to its conclusion.
- Working knowledge and proficiency with Microsoft Office is required.
Equal Employment Opportunity Employer:
Catholic Care Center is an Equal Employment Opportunity (EEO) and Affirmative Action employer. Associates and Applicants receive fair and impartial consideration without regard to race, color, religion, national origin, citizenship, gender identity, sexual orientation, age, physical or mental disability, veteran status, genetic data, or other legally protected status.
Pay Non-Discrimination Notice: https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_ English_formattedESQA508c.pdf
For further information regarding your EEO rights, click on the following link to the “EEO is the Law” poster: http://www.dol.gov/ofccp/regs/compliance/posters/pdf/eeopost.pdf
EEO is the Law Poster Supplement: Please note that Catholic Care Center will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Catholic Care Center will not solicit money or banking information from applicants.
Catholic Care Center is an Equal Employment Opportunity (EEO) and Affirmative Action employer. Associates and Applicants receive fair and impartial consideration without regard to race, color, religion, national origin, citizenship, gender identity, sexual orientation, age, physical or mental disability, veteran status, genetic data, or other legally protected status.
Pay Non-Discrimination Notice: https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_ English_formattedESQA508c.pdf
For further information regarding your EEO rights, click on the following link to the “EEO is the Law” poster: http://www.dol.gov/ofccp/regs/compliance/posters/pdf/eeopost.pdf
EEO is the Law Poster Supplement: Please note that Catholic Care Center will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Catholic Care Center will not solicit money or banking information from applicants.
E-Verify Statement: This employer participates in the Electronic Employment Verification Program.
