Billing & Coding Specialist

Job Summary: Responsible for reading and analyzing patient records to determine the correct codes for billing compliance.  Submit Claims for billing and receiving insurance and patient payments. Verifies, processes and records these payments. Communicates with patients. Performs minor secretarial duties. Participates in the department's performance improvement and continuous quality improvement (CQI) activities.

Demonstrates Competency in the Following Areas:

• Interacting with providers to ensure patient documentation accuracy
• Educate Providers on current ICD and CPT billing regulations
• Audit patient charts and documents for accuracy
• Strong knowledge of anatomy, physiology, and medical terminology
• Review patient claims information for completion and accuracy and obtain any missing information prior to submission to insurance companies
• Follow up with insurance company on unpaid or rejected claims. Resolves issue and re-submits claims
• Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper claim forms
• Completes payment entry in a timely and accurate manner. Identify any payments not being reimbursed at the allowed/contractual amount and communicate this information to the supervisor
• Answers the telephone professionally and in a timely manner; directs calls appropriately
• Answer patient questions on patient responsible portions, copays, deductibles, write-offs, etc. Resolves patient complaints or explains why certain services are not covered
• Collaborate with patients and insurance companies to resolve billing inconsistencies and errors
• Prepares appeal letters to insurance carrier when not in agreement with claim denial. Collect necessary information to accompany appeal
• Work with patients to establish payment plans for past due accounts in accordance with provider policies
• Reconciles front desk daily deposit packets
• Follows HIPAA guidelines in handling patient information
• Treats patients with respect, maintains confidentiality
• Demonstrates a good working relationship within the department and with other departments
• Demonstrates the ability to be flexible and organized
• Other duties as assigned

Knowledge, Skills, and Abilities:

• High School Graduate or equivalent
• A minimum of six months experience in bookkeeping/accounting
• Knowledge of bookkeeping/accounting procedures
• Certification in coding preferred
• Ability to communicate in English, both verbally and in writing
• Additional languages preferred
• Basic computer knowledge required
• Ability to operate office equipment safely and correctly