Medical Billing/Coding Specialist

General Summary:   A nonexempt position responsible for reviewing codes submitted by physicians/providers to assure accurate assignment of HCPCS, ICD 10 and CPT codes for inpatient/outpatient professional charges submitted via encounters, superbills and/or reports. Review encounters, superbills, reports and medical records to assign appropriate billing and diagnosis codes for provider services.

Essential Job Responsibilities

1. Keys charge information into entry program and produces billing.
2. Reviews physicians’ notes and charts for accuracy.
3. Obtains any necessary clarification of information on the notes and charts.
4. Ensures that all medical records have been signed by the appropriate parties.
5. Assigns appropriate medical codes to all diagnoses or services.
6. Identifies and optimizes revenue opportunities.
7. Enters and organizes codes into management software.
8. Reviews charge correction requests.
9. Performs related duties as assigned by Coding Manager.
10. Maintains compliance with Federal, State and payer regulations.
11. Maintains compliance with all company policies and procedures.
12. Works claims and claim denials to ensure maximum reimbursement for services provided.
13. Processes insurance claims including Medicare/Medicaid, managed care and other commercial plans.
14. Researches all information needed to complete billing process including getting charge information from physicians.
15. Works with other staff to follow-up on accounts until zero balance.
16. Assists in error resolution and claim status.
17. Assists with payment posting and collections to ensure patient accounts are current as assigned.
18. Identifies patient accounts due for refunds as assigned.
19. Participates in educational activities, trainings or seminars.
20. Other duties as assigned.

Education:  High school diploma or equivalent.  

Some college preferred.

Experience:  Minimum two years of recent medical billing and coding experience or any equivalent combination of experience.

Performance Requirements:

Knowledge:

1. Knowledge of billing practices and medical office policies and procedures.
2. Knowledge of medical coding (CPT and ICD-10), clinic operating policies and third-party operating procedures and practices.
3. Knowledge of anatomy, medical and procedural terminology.
4. Knowledge of legal and regulatory government provisions.
5. Knowledge of HIPAA Privacy and Security rules.

Skills:

1. Skill in establishing and maintaining effective internal and external working relationships.
2. Skill in verbal and written communication with patients and insurances.
3. Skill in accuracy, detail and organization.
4. Skill in problem solving.
5. Skill in customer service.

Abilities:

1. Ability to work in team based work setting which places patient satisfaction as the major focal point for measuring success.
2. Ability to demonstrate compassion and caring in dealing with others.
3. Ability to project a pleasant and professional image.
4. Ability to effectively articulate information and respond to questions.
5. Ability to relate to and work well with a diverse community population.
6. Ability to work under pressure and meet deadlines, while maintaining a positive attitude.
7. Ability to multi-task and meet deadlines.
8. Ability to work cooperatively with other department staff.
9. Ability to plan, prioritize, and complete delegated tasks in an appropriate time frame.
10. Ability to read, interpret and apply policies and procedures.
11. Ability to follow oral and written instructions.
12. Ability to set priorities among multiple requests.
13. Ability to interact with patients, medical and administrative staff, and the public effectively.
14. Ability to work with computers (MS Office – Word, Excel and Outlook).
15. Ability to differentiate between primary and secondary insurance payers.
16. Ability to work independently and to carry out assignments to completion within parameters of instructions given, prescribed routines, and standard accepted practices.
17. Ability to operate standard office machines and equipment, including telephones, computers, copy machines, fax machines, calculators, scanners and shredders.
18. Ability to safely and successfully perform the essential job functions consistent with the ADA, FMLA and other federal, state and local standards, including meeting qualitative and/or quantitative productivity standards.
19. Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local standards.