Billing Specialist

Description

PURPOSE:

 

Reporting to the Billing Team Supervisor, the Billing Specialist is responsible for accurate and timely claim submissions, follow ups and denial management. The Billing Specialist is well-versed in CPT, HCPCS and ICD-10 coding, applying this knowledge to ensure the highest level of reimbursement is achieved following payer guidelines and standards.

 

ACCOUNTABILITIES AND JOB ACTIVITIES:

 

• Review encountered superbills to ensure the provider captured all CPT and ICD-10 codes accurately
• Review clinical documentation to confirm accuracy
• Submit reviewed claims in a timely manner as outlined by the Billing Team Supervisor
• Analyze errors, identify trends, and provide feedback to the Billing Team Supervisor and providers
• Edit claims for modifier, coding, and bundling errors
• Review denied claims and initiates appeals when applicable
• Ensure all coding and documentation meets all payer guidelines and standards
• Provide coding and documentation feedback to providers and staff
• Investigate overpayments and payer refund requests, initiate take backs and process refunds on a regular basis in accordance with payer policies
• Manage work queues timely and effectively
• Assist with patient and payer inquiries
• Ability to share knowledge with team members and department leaders throughout the organization
• Receive patient payments via telephone
• Other duties as assigned

 

Develop and maintain personal and professional skills

 

• Attend all mandatory staff meetings per year unless excused as evidenced by documentation
• Attend mandatory in-services and a minimum of two pertinent in-services per year as documented
• Actively participate in performance improvement activities as observed or documented
• Establish realistic professional goals as evidenced by the annual performance evaluation
• Actively keep abreast of departmental and organizational activities
• Demonstrate flexibility in response to unexpected change in workload or situations as observed
• Serve on committees and/or participates in changes of policy and procedures that affect the revenue cycle
• Assist in the orientation of new personnel as directed
• Support the mission and goals of the company as observed
• Address all emails within 24 hours as documented
• Perform other duties as required

 

Demonstrate safe and cost-effective practice

 

• Consistently adhere to OSHA bloodborne pathogen guidelines; apply universal precautions per company standards as observed
• Consistently utilize proper body mechanics as observed
• Accurately complete incident reports within the shift of occurrence and immediately communicates critical incidents to the appropriate person per the organizational chart
• Consistently allocate resources to reduce waste and minimize costs as observed
• Consistently complete assigned duties within stated shifts in a timely manner as observed and documented               

                                                           

BEHAVIORAL EXPECTATIONS

 

Strive for excellence

 

• Set challenging goals
• Produce quality work in a timely fashion
• Maintain current knowledge and skill
• Participate in quality and process improvement efforts
• Keep the work area clean, safe and secure

 

Act Flexibly

 

• Adapt to change
• See the value of different opinions and new ideas
• Change plans and objectives given new direction or priorities
• Handle stressful situations effectively

 

Meet Customer Needs

 

• Meet internal and external customers’ needs
• Find new ways of satisfying customers
• Participate in service improvements efforts
• Listen and respond to customers
• Treat customers with compassion and respect

 

Work as a Team

 

• Work as a team player
• Pitch in to help those in need
• Communicate with others appropriately
• Listen and respond to others
• Handle conflict situations effectively
• Foster trust and respect within the team
• Participate in committees and task forces

 

           

            Foster Diversity in the Workforce

 

• Treat all associates and customers with respect, integrity and dignity regardless of background, race, age, gender, gender identity, sexual orientation, religion or disability
• Treat all associates and customers fairly

 

Be Self-directed

 

• Take initiative and responsibility for actions
• Identify own learning needs and create/implement Learning Plans
• Perform duties according to policies and procedures
• Demonstrate ethical behaviors
• Maintain confidentiality of information
• Maintain licenses and certifications as appropriate
• Fulfill operating unit/clinical competencies
• Use equipment/resources responsibly

           

You must refer to upper management for approval or final disposition on the following

 

• Change in procedure
• Difficult patient situations
• Any situation you are unsure of

 

JOB SCOPE AND WORK ENVIRONMENT:

 

This position is subject to:

 

• Confidential information
• Extended time sitting at a desk, utilizing a keyboard and multiple monitors
• High stress environment due to turnaround requirements
• Daily hours are subject to change on a daily basis due to schedule

           

Patient Privacy HIPAA

 

• Protection of patient privacy
• Patient records and EMR are for treatment use only

 

The statements in this job description are intended to describe the essential nature and level of work performed by employees assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of personnel so classified.

Qualifications

JOB REQUIREMENTS

 

	COMPETENT LEVEL QUALIFICATIONS	MINIMUM LEVEL QUALIFICATIONS
SKILLS (Typing and special machinery)	-Knowledge of Electronic Medical Record -Good typing skills -Good internet navigation skills	-Knowledge of instrumentation used in office (fax, credit card, copy) -Knowledge of multi-line phone system -Excellent Verbal and Written Communication skills -Knowledge of medical terminology with a strong focus on the spine and skeletal system. - Advanced knowledge and skill in CPT, ICD-10-CM and HCPCS code assignment -Knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding, and billing, with demonstrated ability to interpret such guidelines
EDUCATION AND EXPERIENCE (Degrees, years in profession)	-Previous hospital/ambulatory surgery center, or physician billing experience preferred	-Minimum of 2 years of coding/billing experience in a physician practice setting.
Special Job Characteristics		-Fast paced work environment with established time constraints -Must be able to work overtime when required -Must be able to multitask while maintaining accuracy -Must work well with others

 

OTHER REQUIREMENTS:

 

• Knowledge of common safety hazards and precautions to establish a safe work environment
• Must be able to act calmly and effectively in busy, stressful or emergency situations
• Ability to communicate effectively in person, by phone and in writing
• Require adherence to all policies and procedures, including standards for safety,   attendance, punctuality and personal appearance
• This position must be willing to do any additional tasks as assigned by management

 

PHYSICAL REQUIREMENTS:

 

HEARING: Adequate to perform job duties in person and over the telephone.

 

SPEAKING: Must be able to communicate clearly to patients & staff in person and over the telephone.

 

VISION: Requires eyesight correctable to 20/20 to operate equipment and read information from printed sources and computer screens.

 

OTHER: Requires frequent lifting and carrying items weighing up to 50 pounds unassisted, including assisting patients when required. Adequate physical ability to be present where needed.

Requires frequent bending, reaching, repetitive hand movements, standing, walking, squatting and sitting, with some heavy lifting, pushing and pulling exerted regularly throughout a regular work shift. Requires exposure to communicable diseases, bodily fluids, medicinal preparations and other conditions common to a clinic environment.

 

The above is intended to describe the general content and requirements for the performance for this position. It is not to be construed as an exhaustive statement of duties, responsibilities

or requirements. I have read the job description and understand the functions and objectives of the position at this company. This position must be willing to do any additional assignment by management.