Medical Billing Specialist

These organizations seek a seasoned Foreign Medical Program (FMP) Veterans Affairs (VA), TRICARE, and CHAMPVA Billing Specialist to oversee billing and reimbursement operations, guaranteeing the precise and prompt processing of insurance claims. The preferred applicant shall demonstrate independent problem-solving abilities, meticulous attention to detail, and exceptional communication, collaborative, organizational, and time management proficiencies.

Adheres to accepted coding practices, guidelines and conventions when choosing the most appropriate diagnosis, operation, procedure, ancillary, or evaluation and management (E/M) code to ensure ethical, accurate, and complete coding.

Codes inpatient professional fee services for identified inpatient admissions. Code selection is based upon strict compliance with regulatory fraud and abuse guidelines and VA specific guidance for optimum allowable reimbursement.

Applies advanced knowledge of medical terminology, anatomy & physiology, disease processes, treatment modalities, diagnostic tests, medications, procedures as well as the principles and practices of health services and the organizational structure to ensure proper code selection.

Selects and assigns codes from the current versions of the International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and/or Healthcare Common Procedure Coding System (HCPCS).
Reviews and codes assigned fee service Care in the Community outpatient encounters using the paper or electronic documentation obtained from non-VA facilities

Primary Duties:

• Full cycle billing for Fort Bello Health & Wellness, iWellness Vet Center & Lab RX DR
• Work claims from billing to follow-up
• Analyze, research and process insurance claims through electronic claims management systems in a timely manner
• Ensure accurate and complete clean claim submissions
• Processes claims updates based on direction given by facility
• Evaluates insurance rejections in order to re-transmit with corrected claims information and follow-up with the FMP VA, TRICARE, and CHAMPVA claims departments
• Investigates re-bill requests submitted to the billing department and processes these requests when appropriate
• Audits claims/accounts for charges, duplications, and overlapped accounts prior to billing, making any necessary adjustments
• Documents actions taken in collection system
• Informs Billing Managers of any charging trends or edits trends and provide examples/education to other departments to reduce errors
• Ability to perform all other duties a assigned or requested

Skills **

Computer skills, billing systems, billing customer service, billing software, medical billing and coding, medical claims, prior authorization, Veteran Affairs procedures in billing and follow-up

Additional Skills & Qualifications

-VA FMP

-TRICARE Overseas

-CHAMPVA

Experience & Education:

• Experience: One year of creditable experience that indicates knowledge of medical terminology, anatomy, physiology, pathophysiology, medical coding, and the structure and format of a health records. OR,
• Education:
• An associate's degree from an accredited college or university recognized by the U.S. Department of Education with a major field of study in health information technology/health information management, or a related degree with a minimum of 12 semester hours in health information technology/health information management (e.g., courses in medical terminology, anatomy and physiology, medical coding, and introduction to health records). OR,
• Completion of an AHIMA approved coding program, or other intense coding training program of approximately one year or more that included courses in anatomy and physiology, medical terminology, basic ICD diagnostic/procedural, and basic CPT coding. The training program must have led to eligibility for coding certification/certification examination, and the sponsoring academic institution must have been accredited by a national U.S. Department of Education accreditor, or comparable international accrediting authority at the time the program was completed. OR,
• Certification: Persons hired or reassigned to MRT (Coder) positions must have either (1), (2), or (3) below:
• Apprentice/Associate Level Certification through AHIMA or AAPC.
• Mastery Level Certification through AHIMA or AAPC.
• Clinical Documentation Improvement Certification through AHIMA or ACDIS.

Job Type: Full-time

Pay: $41,000.00 - $60,000.00 per year

Benefits:

• Health insurance
• Paid time off

Schedule:

• 8 hour shift
• Day shift
• No weekends

Ability to Commute:

• Pinehurst, NC 28374 (Required)

Ability to Relocate:

• Pinehurst, NC 28374: Relocate before starting work (Required)

Work Location: In person

Salary : $41,000 - $60,000