Certified Coding & Billing Specialist

Description

Position Title: Clinical Coding Billing Specialist Certified

   Supervisor: Chief Executive Officer FLSA Classification: Exempt

 POSITION SUMMARY: Under the direct supervision of the Manager of Revenue Cycle, the Clinical Coding and Billing Specialist is responsible for all components of coding and billing for all Phoenix Behavioral Health entities.  Collaborates with the Manager of Revenue Cycle to establish, design, implement, and enforce policies and procedures related to coding and billing per CMS and coding guidelines. 

Applications utilized include: Kipu, CollaborateMD, Codify, Monday Board, Excel, Word, Power Point. 

GENERAL REQUIREMENTS/QUALIFICATIONS COMPETENCIES:

• Computer experience and working knowledge of MS office suite, KIPU and CollaborateMD experience preferred.
• Must be able to communicate effectively in English (verbal/written).
• Expert knowledge of regulatory compliance issues, ICD-10 and CPT-4 medical record coding and UB04 and HCFA billing.
• Working knowledge of facility and provider charge description master (CDM).
• Demonstrated knowledge with Joint Commission and Medicare standards.
• Experience with HIPAA compliance standards and guidelines required.

• Demonstrated knowledge of payer reimbursement procedures and methodologies.  
• Ability to work independently while effectively managing different priorities and projects.  
• Ability to read, analyze, and interpret common and technical journals, statistical reports, and other related documents.   
• Ability to effectively present information to management. 
• Ability to define problems, collect data, establish facts, and draw valid conclusions that drives process improvement, quality, and productivity.  
• Ability to analyze business situations, controls and risks, and recommend practical solutions.  

ESSENTIAL FUNCTIONS and BASIC DUTIES:

 Responsible for the daily coding, billing, and submission of all Phoenix Behavioral Health claims.

• Performs all aspects of facility and professional coding including diagnosis, E/M office and hospital visit levels, and/or procedures with an accuracy of 95% or better.
• Accountable for the timely completion of coding and billing edits, denials, and/or inquiries.
• Responsible for submission and tracking to resolution of appropriate and required provider queries, including escalation of delinquent queries to Manager of Revenue Cycle.
• Continuously seeks ways to streamline the coding and billing process by working with the Manager of Revenue Cycle to maintain compliant documentation, coding and billing practices.
• Ensure proper and timely billing of all patient accounts for both primary and secondary claims.
• Identify and correct coding and/or billing errors, denials, and/or rejections.
• Responsible for resubmission of corrected electronic claims.
• Accountable for daily review and reconciliation of all unbillable claims, including escalation of delinquent, unresolved issues.
• Attends all meetings with Manager of Revenue Integrity and Manager of Revenue Cycle regarding new and/or updated coding and billing documentation payment guidelines. 
• Serves as subject matter expert (SME) for coding and billing issues and/or requests.
• Leads complex projects related to coding initiatives.
• Assesses the accuracy and completeness of medical records and reports findings to the Manager of Revenue Cycle.
• Provides support to Collections Department to resolve coding and billing issues.
• Ability to communicate effectively with physicians, nurses, and clinical departments.

• Must be organized and ability to prioritize work.
• Resolves issues and problems of software systems and discusses with software analysts.
• Possesses a thorough working knowledge of coding and billing requirements for various payers. 

Excellent communication skills both written and verbal, and interpersonal skills

• Builds positive relationships with staff and physicians.
• Works collaboratively with Staff.
• Performs other job-related duties as required.  
• Supports the Manager of Revenue Cycle and other RCM Management by assisting with research of issues arising from medical record documentation and audits. 
• Supports the Manager of Revenue Cycle and other RCM Management by presenting recommendations of QA activities geared to address specific areas of high risk in medical record documentation adequacy and compliance. 
• Demonstrates adaptability and flexibility to changes in the work environment.
• Performs other tasks, as assigned. 
• Completes other tasks, as assigned by supervisors
• Performs other job-related duties within the job scope as requested by RCM Management. 

• Protects confidential and protected patient health information and maintains strict confidentiality in accordance with HIPAA Laws, regulations and company policy. 
• Presents a positive, professional appearance and conveys a professional demeanor in the performance of assigned duties. 
• Embodies the values of the organization’s mission, vision, and goals always. 

• Represents Phoenix Behavioral Health in a positive and professional fashion and makes all   individuals feel as comfortable as possible. 
• Conducts all business in a professional manner maintaining respect for all individuals. 

• Complies with departmental and company-wide policies and procedures. 

• Maintains constant awareness of potential safety hazards ensuring necessary safety precautions. 
• Reads and complies with established Organization’s and Patient Accounts policies and procedures. 
• Exemplifies the highest levels of quality and integrity aligned with the organization’s standards, policies and procedur

MINIMUM EDUCATION AND LICENSURE/CERTIFICATION:

 Associate’s degree in related field and/or completion of a formal billing and coding program required; one-year facility and/or physician coding and billing experience preferred.

• Certification/Licenses: Current CBCS, CPC, COC, CMC, CCS, CCS-P, RHIT, and/or RHIA required Minimum 5 years of progressive leadership experience in behavioral health, substance use, or healthcare.
• Proven experience with DCF, Joint Commission, and AHCA compliance, staff management, and budget oversight.
• Proficiency in Microsoft Office Suite and EMR systems.  

Key Performance Indicators (KPIs) The Executive Director will be evaluated based on performance across the following measurable KPI’s:

PHYSICAL DEMANDS/ WORK ENVIRONMENT REQUIREMENTS:

 TYPICAL WORKING CONDITIONS:

Work is typically performed in an office environment. Will spend majority of time working on a computer, using office equipment, working with patients. Frequently interacts directly or over the phone with staff members during the workday. May be required to travel between facilities. Must have the ability to work the hours and days required to complete the essential functions of the position.

Qualifications

Required Education:
- High school diploma or equivalent

Required Experience:
- 2 years of experience in billing or a related field
- Experience with accounting software
- Experience with Microsoft Office Suite

Required Skills and Abilities:
- Strong attention to detail
- Excellent organizational skills
- Ability to work independently and as part of a team
- Excellent communication and interpersonal skills
- Ability to meet deadlines and handle multiple tasks simultaneously
- Knowledge of billing procedures and regulations
- Ability to resolve billing discrepancies
- Ability to maintain confidentiality
- Ability to work in a fast-paced environment