Billing and Coding Specialist

Position Summary:
The Billing and Coding Specialist is responsible for reporting accurate information to the insurance company ensuring that the clients of Riverside Recovery of Tampa are billed correctly. This is a critical position in the financial cycle and requires attention to detail. This position will work closely with the Billing and Coding Manager, Certified Professional Coder, and other departments as well to ensure that medical claims are sent to the insurance companies and clients.

This position offers the opportunity to work remotely.

Essential Duties and Responsibilities:
To perform this job successfully, an individual must be able to perform the following satisfactorily; other duties may be assigned. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
•Manages all claims submission and payment posting
•Ensures data is formatted, coded, and submitted in an accurate and compliant manner
•Submits claims files to payers and posts payments using Electronic Data Interchange (837p and 835ERA)
•Identify and implement coding and submission requirements of individual payers and funding sources.
•Monitors payer and clearinghouse submission reports and troubleshoots problems
•Monitors payer correspondence for updates and information affecting the claims process or reimbursement
•Monitor that the insurance electronic claim billing process is completed successfully daily.
•Ensures claims are submitted within a timely manner.
•Maintains and ensures the integrity of billing and claims related data
•Analyzes claims and billing data to identify trends and examine claim denial issues
•Communicate with health insurers regarding pending and any unpaid claims.
•AR follow-up and denials. Research denials, submit appeals and ensure payments are received on all outstanding claims.
•Follow up with 3rd party organizations after careful review of claims with Overpayment/Recoup Requests
•Post all insurance payments to the patient’s accounts in CMD.
•VA accounts will be the responsibility of the manager, billing and coding specialist will assist as needed upon request
•Maintains line of communication and serves as the primary contact for all claims and billing matters payer assigned
•Understands claims data elements and structure in detail pertaining to Substance Abuse & Mental Health services and appropriate diagnoses assigned

•Ensures that client accounts are private and notifies clients when claims have not been paid in accordance with the accounts receivables policy

•Demonstrates knowledge of and supports RR’s mission, vision, value statements standards, policies and procedures, operating instructions, confidentiality standards and the code of ethical behavior.

•Exercises excellent organization skills and is able to multitask will little oversight

•Works independently and exercises good time management

•Communicates professionally and respectfully with all departments

•Ensure strict confidentiality of medical and financial records and follow HIPPA and confidentiality guidelines.

•Assist the team with Verification of Benefits as needed.

•Maintenance to include CEU education to keep CPC certification current.

•Other duties as assigned

Full time Eligible Benefits:

· Health Insurance

· Dental

· Vision

· 401- K

· Life Insurance

· Disability

· Critical Illness

· Hospital Indemnity/Accident plan

· Legal plan

Employer Paid Benefits:

· EAP

· $10,000 life insurance  

· $10,000 Short term Disability

Qualifications:
•High school diploma, GED or equivalent
•1 - 2 years of Medical Billing Experience within Substance Abuse or Mental Health
•Completion with an Accredited Medical Billing & Coding Diploma Program
•Excellent Customer Service skills
•Strong working knowledge of inpatient & outpatient medical coding required
•Excellent computer and reporting skills, including proficiency in data set filtering, sorting and grouping using MS Excel.
•Ability to manage multiple applications and records simultaneously while maintaining data integrity.
•Familiarity with electronic medical records and claims/practice management systems.
•Must be knowledgeable of applicable laws and regulations governing substance abuse treatment facilities and mental health including, but not limited to, HIPAA and Title 42 - Part 2.

Salary : $21 - $25