What are the responsibilities and job description for the HCC Billing and Coding Specialist position at Central Florida Health Care, Inc.?
Title: HCC Billing and Coding Specialist
Reports to: Director of Revenue Cycle Management
FLSA Status: Non-Exempt
Personnel Supervised: None
Personnel Supervised: None
POSITION SUMMARY:
Under general supervision the position is responsible for billing, coding, posting, assigning correct payer sources, submitting clean claims to insurances and follow up for on denial claims in order to maximize the revenue cycle through billing and coding expertise. Reviews, analyzes and assures the final diagnoses and procedures as stated by the practicing providers are valid and complete. Train and educate staff regarding proper billing and coding practices. HCC Coder determines the appropriate ICD10-CM diagnoses codes based on clinical documentation that follows the Official Guidelines for Coding and Reporting and Risk Adjustment guidelines for Hierarchical Condition Categories (HCC). HCC Coding is a risk adjustment model designed to estimate future costs for patients. HCC coding relies on ICD-10-CM coding to assign risk scores to patients. The incumbent reviews retrospective medical record documentation and ensures that the codes are appropriately assigned. The outcome will be documentation that accurately and completely captures the clinical picture/severity of illness/complexity of the patient while providing specific and complete information to be utilized in coding, profiling and outcomes reporting of Central Florida Health Care.
MINIMAL QUALIFICATIONS:
- High School Diploma
- Medical Coding Certificate – CPC or CCS certification required
- Excellent interpersonal skills
- Two years’ experience using ICD coding, CPT, HCPS or equivalency
RESPONSIBILTIES AND PERFORMANCE EXPECTATIONS include, but are not limited to, the following:
- Assesses adequacy of health record documentation in order to support accurate, complete and specific assignment of modifiers, International Classification of Diseases (ICD), Current Procedural Terminology (CPT) and Health Common Procedural Coding (HCPC) codes to maximize reimbursement.
- Reviews record to ensure that the appropriate billing provider, required attachments, signatures and other relevant documentation to reflect treatment and services rendered are presence as required.
- Properly assigns and correct as warranted procedure, modifier and diagnosis codes supported by provider documentation. Appropriately queries provider for clarification or additional documentation needed for processing a clean claim.
- Generate and process claims from provider documentation to submit claims to appropriate payer in accordance with Medicare, Medicaid and Managed Care policies for proper reimbursement.
- Researches and ensures corrections are made on denied claims due to missing or incorrect information. Follows up with appropriate party as warranted regarding denials and payments.
- Review claims in holding status to process claims in a timely manner.
- Provides recommendations to Director of Revenue Cycle Management regarding accounts receivables, coding and billing practices
- Attends seminars and in-services as required to remain current on coding issues
- Maintains all mandatory in-services
- Maintains compliance standards in accordance with the Compliance policies and the Code of Conduct. Reports compliance problems appropriately.
- Determine the final diagnoses and procedures stated by the physician or other health care providers are valid and complete.
- Federal laws and regulations affecting coding requirements
- Principles, practices and methods of current coding certificate required
- Modern/Best office practices
- Knowledge of billing practices required, FQHC preferred
- Knowledge of medical records, E H R required
- Extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes
- Must have good math skills and effective communication skills
- Perform coding work requiring independent judgement with speed and accuracy
- Examining and verifying coding errors through audits
- Required in-services
- Communicating clearly and concisely, orally and in writing
- Confidentiality
- Ability to use the computer
- Ability to work independently to accomplish assigned work in a timely manner
- Ability to communicate with staff and the public, both in person and over the phone, in a tactful manner and under difficult situations
- Understanding and carrying out verbal and written directions
- Follow CFHC policies and procedures
- Works independently in the absence of supervision
- Performs other related duties, which may be inclusive, but not listed in the job description
BENEFITS:
Competitive Salary
Federal Student Loan Forgiveness:
PSLF – 10-year commitment, 120 loan payments and at the end of the commitment, the remaining loan is forgiven
Excellent medical, dental, vision, and pharmacy benefits
Employer Paid Long-Term Disability Insurance
Employer Paid Life Insurance equivalent to 1x your annual salary
Voluntary Short-Term Disability, additional Life and Dependent Life Insurance are available
Malpractice Insurance
Paid Time Off (PTO) – 4.4 weeks per year pro-rated
Holidays (9.5 paid holidays per year)
Paid Birthday Holiday
CME Reimbursement
401k Retirement Plan after 1 year of service (w/matching contributions)
Staff productivity is recognized and rewarded
PHYSICAL REQUIREMENTS:
- Works under pressure and stress due to the diversity of our clinics
- Work is performed indoors in a heated, air conditioned, well lighted and clean office setting
- Requires frequent lifting up to 20 pounds, and infrequent lifting up to 50 pounds
- Requires ability to distinguish letters, numbers and symbols
- Requires normal range of vision
- Requires awareness of personal limitations and flexibility
- Some emotional stress resulting from diversity and intensity of patients and staff
- Requires prolonged standing or sitting
- Occasional travel required
American with Disabilities Act (ADA) Statement: External and internal applicants, as well as position incumbents who become disabled, must be able to perform the essential job specific functions (listed within each job responsibility) either unaided or with the assistance of a reasonable accommodation to be determined by the organization on a case by case basis.