Experienced Billing & Coding Specialist

Summary:
The Billing and Coding Specialist is responsible for submitting and receiving payments for third-party insurance and coding provider documentation as required to submit for third party reimbursement. They respond and address any problems regarding patient insurance coverage and their financial responsibilities. They also perform other duties as delegated by the Revenue Cycle Manager.

 

·Maintains confidentiality of all health center information within the bounds of patient and professional confidentiality

·Adheres to all health center policies and procedures and complies with personnel, administrative and Board requirements at all times

·Follows chain-of-command and completes assignments and/or other duties as assigned from the Billing and Coding Manager

·Encourages the mission and goals of the health center at all times, maintaining a cooperative and positive work relationship and promoting teamwork, cooperation and equitable treatment of all health center employees

·Consistently demonstrates superior job knowledge and skills to completely perform all job responsibilities

·Maintains appropriate computer information, diagnosis codes, CPT codes, all third-party carriers, lab codes, and accounts

·Monitors and maintains ongoing maintenance of paper insurance claim forms and electronic billing changes regularly and accurately

·Submit and follow-through on payments of claims for third-party billing (fee-for service/capitated/out of state company) for medical services rendered on a weekly basis, as assigned by the Billing and Coding Manager

·Responsible for billing, follow-up, and working denials for insurances assigned by the Billing and Coding Manager

·Communicate clearly with patients regarding insurance coverage and his/her financial responsibilities. Notifies the Billing and Coding Manager of any unresolved problems or patient complaints immediately

·Submit and follow through on work comp, disability, and other accident claims for health center patients including medical updates and treatment plans in a timely manner

·Works with Patient Service Representative regarding patient referrals and authorizations by insurance companies and responds to problems with referral issues related to insurance billing

 

·Assists with all insurance company audit reviews as required by participating companies

 

·Maintain Medicare claim investigation program as required by CMS (Medicare) within the specified time limit, as assigned by the Billing and Coding Manager

·Completes bad debt write-off of past due inactive accounts with approval by the Billing and Coding Manager

·Monitors medical practice software program needs and communicates with service provider regarding any problems, proposed and/or requested changes as needed.  Follows through with unresolved requests as soon as possible

·Financial Counseling of high balance accounts offering slide fee applications, payment plans, and/or assistance in applying for Medicaid. 

·Responsible for collections of self-pay balances through letters and phone communication as assigned by the Billing and Coding Manager

·Run and check month end reports, accounts receivables, and patient billing for accuracy and reporting requirements.  Reports any discrepancies to the Billing and Coding Manager as they occur. 

·Provide back-up when another Billing Specialist is absent

·Performs other duties as delegated and assigned by the Billing and Coding Manager

·High School Graduate or equivalent 

·Preferred certification in Medical Billing and Coding

·Preferably at least two years’ experience in billing and coding at a healthcare facility

·Willingness to get coding certification

·Ability to complete tasks in a timely manner with minimal supervision