Billing and Coding Specialist

Billing and Coding Specialist - Medicare Expert

JOB RESPONSIBILITIES

Under minimal supervision, the Billing and Coding Specialist is responsible for processing and managing Medicare billing, ensuring compliance with all relevant regulations, and providing expert clerical support to the Billing Department.

PROCESSING DUTIES

• Process manual and electronic billing specifically for Medicare, Medicaid/HMO, private, and contractual funding sources.
• Ensure all claims include the correct rendering NPI number and meet Medicare-specific documentation requirements.
• Confirm that services have an active Prior Authorization when applicable, particularly for Medicare services.
• Accurately process billing with procedure codes, service dates, amounts, and diagnostic codes, adhering to Medicare billing guidelines.
• Generate and maintain spreadsheets for each contractual client, verify funding sources, and update the process monthly with a focus on Medicare-related cases.
• Enter and summarize billing information for Medicare services.
• Pull and review charts to ensure they meet Medicare documentation requirements.
• Document services rendered as required, ensuring alignment with Medicare billing standards.
• Adhere strictly to confidentiality laws (HIPAA) and Medicare regulations.
• Follow the organization’s policies and procedures with an emphasis on Medicare billing practices.

CUSTOMER SERVICE DUTIES

• Collaborate effectively with other departments to ensure accurate and timely Medicare billing.
• Provide expert advice and guidance on Medicare billing practices to colleagues and stakeholders.

OTHER DEPARTMENT DUTIES AS ASSIGNED

• Participate in staff development training and workshops, particularly those focused on Medicare billing updates and compliance.
• Enter data as required in the database system, with a focus on accuracy in Medicare billing.
• Generate correspondence as needed, particularly related to Medicare billing issues.
• Perform other department duties as assigned.