Medical Billing and Coding Specialist

Description

Job Summary: The Medical Billing & Coding Specialist assures accurate and complete information is collected and reported to private insurance, Medicare, and Medicaid to help complete the revenue cycle. The specialist will scrub encounters for accurate coding prior to claim creation, follow-up on claim denials, obtain pre-authorizations for certain procedures. The candidate should have knowledge of insurance regulations and medical coding with the goal of maximizing accurate third-party billing.

 Duties and Responsibilities:

· Accurately and timely submit medical claims to insurance companies and other payers

· Ensure codes are accurate and sequenced correctly in accordance with government and insurance regulations

· Review and analyze medical records to ensure appropriate coding of diagnoses and procedures. Follow up with providers on any documentation that is insufficient or unclear

· Assigns or reassigns CPT, HCPCS, and ICD-10-CM codes as needed

· Good understanding of E/M Guidelines

· Following up on unpaid claims and initiating appeals for denied ones within standard billing cycle timeframes

· Tracking the progress of claims through the clearinghouse and promptly address any issues

· Provides timely and professional customer service, resolve patient billing issues, answer questions from patients, facility staff, and third-party vendors

· Review insurance and patient aging reports 

· Staying updated on healthcare regulations, medical terminology, and coding practices

· Follows HIPAA guidelines when accessing and sharing patient information

· Tracking, reviewing, and reporting on billing metrics, trends, and periodic audits to ensure compliance and accuracy.

· Maintain compliance with all regulatory and accrediting institutions

· Perform other job-related duties as assigned.

Other Responsibilities

Perform general office duties such as typing, filing, photocopying and report generation, answer telephone and emails, inventory, and ordering supplies. Abide by all state, district, and agency policies regarding confidentiality of patient information.

Requirements

  Knowledge, Skills, and Abilities:

• Knowledgeable on insurance and reimbursement process.
• Good math and data entry (typing) skills.
• Exercises good judgement and discretion.
• Familiarity with HIPAA privacy requirements for patient information. Maintains and protects confidential information.
• Proficient in the use of computers and common office equipment.
• Good verbal and written communication skills.
• Basic understanding of medical ICD 10 codes and CPT medical billing codes.
• Good telephone and patient relationship skills.
• Detail oriented and ability to prioritize work.
• More experienced insurance billing specialists work with minimal direction and oversight. 
• Basic Knowledge of Ryan White HIV/AIDS program is essential. 
• Ability to collect, synthesize and research complex or diverse information. 
• Ability to establish and maintain effective working relationships with a variety of clients who are living with HIV/AIDS to collect, verify, organize, and analyze information to determine eligibility for health insurance coverage
• Must be able to demonstrate ethical behavior in diverse situations and use critical thinking skills.

Minimum Qualifications:

Associate degree (bachelor's degree in business or related filed preferred), and two years of experience as a Medical Biller/Coder for medical and behavioral health services

Or

Any equivalent combination of training and experience (via AAPC or equivalent curriculum) which provides the required knowledge, skills, and abilities.

License/Licensure:

Certified Billing/Coding