Billing Integrity Specialist-Allergen Immunotherapy

POSITION: Billing Integrity Specialist – Allergen Immunotherapy

RESPONSIBLE TO: Supervisor, Allergen Immunotherapy Billing

JOB SUMMARY: The Billing Integrity Specialist - Allergen Immunotherapy reports to the Supervisor, Allergen Immunotherapy Billing. Primary duties include: entering allergen immunotherapy charges and reviewing for accuracy in compliance with federal and other payer coding and billing regulations and guidelines; following established AP protocols and payer policies to ensure accurate entry of CPT codes and billing of allergen immunotherapy; researching payer manuals and guidelines related to allergen immunotherapy billing rules and notifying the Supervisor, Allergen Immunotherapy Billing with updates.

RESPONSIBILITIES INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING:

• Performs assigned duties within the designated timelines and performance standards.
• Complies with Federal, States and payer requirements.
• Enters allergen immunotherapy charges in accordance with payer claims editing and other payer policies, and AP policies and procedures.
• Recommends to the team lead improvements to processes and/or policy and procedures.
• Interacts with practice managers and staff regarding billing and payer policies, procedures, and regulations as they relate to allergen immunotherapy charge entry.
• Reviews medical record documentation to determine if refill, restart, reformulation, and new orders are appropriate in accordance with Allergy Partners policy.
• Follows established protocols and conducts research on payer policies related to allergen immunotherapy billing.
• Researches, analyzes, and responds to internal inquiries regarding allergen immunotherapy charge entry, billable services and denials.
• Work interdepartmentally to ensure that all charges are entered into practice management system according to established Allergy Partners protocols and payer guidelines.
• Maintain in depth knowledge of payer requirements, both clinical guidelines and reimbursement policies.
• Assist billing representatives in accounts receivable with insurance denials by reviewing medical records, educating on billing issues as identified, and facilitating resolution.
• Assists with resolving billing issues and reviews medical record documentation in conjunction with the AP pre-billing review process.
• As assigned, assists with special billing integrity projects.
• Models the AP Code of Conduct and demonstrates a commitment to the AP Compliance Program, standards and policies.
• Completes all assigned AP training within designated timeframes.
• Performs miscellaneous job-related duties as assigned.

OTHER

• Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated timeframes.
• Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance & Privacy or via the AP EthicsPoint hotline.
• Models the AP Code of Conduct and demonstrates a commitment to the AP Compliance Program, standards and policies.

SUPERVISORY RESPONSIBILITIES

This position has no supervisory duties.

TYPICAL PHYSICAL DEMANDS

• No or very limited exposure to physical risk.
• No or very limited physical effort required.
• Work is normally performed in a typical interior/office work environment.

EDUCATIONAL REQUIREMENTS:

• High school diploma or GED equivalent.
• Coding certification from AHIMA or AAPC, preferred

QUALIFICATIONS AND EXPERIENCE:

• Two years of physician office charge entry/billing following complex rules.
• Two years of experience in physician office operations.
• Oral and written communication skills.
• Competent in use of Microsoft Office Excel and Word, and electronic health records.
• Four years of physician charge entry following complex rules, preferred
• Two years of experience in billing for multiple physicians and locations, preferred
• Experience with practice management software and an EMR, preferred
• Knowledge of medical terminology, preferred
• Experience in allergy specialty physician billing, preferred
• Knowledge of billing and coding complexities related to specialty physician office charge entry.
• Ability to use independent judgment and to manage and impart confidential information.
• Understands the Health Insurance Portability and Accountability Act (HIPAA) and maintains confidentiality and privacy of protected health information (PHI).
• Ability to analyze and solve problems.
• Strong communication and interpersonal skills.
• Knowledge of regulatory and policy issues related to coding and billing.
• Knowledge of current and developing issues and trends in medical billing and payer requirements.
• Ability to clearly communicate billing requirements to providers, practice managers and to staff.
• Understanding of and experience with electronic health records; computer applications used for physician practice management and billing.
• Excellent organizational skills and the ability to manage multiple tasks within designated timelines.
• Ability to communicate and work proficiently interdepartmentally.