Billing & Coding Specialist

Title: Billing and Coding Specialist 
Division: Finance
Department: Finance
FLSA Status: Non-Exempt
Reports To: Director, Billing Services
Direct Reports: None

Purpose: Works all patient and client accounts to industry-specific applications to include invoice creation, billing and posting receivables, i.e. eMD’s, Medent, AIRS, NetSmart, Millin, Scriptpro, TPMS, Trizetto, Emdeon, Ability, FundEZ.  Audit all patient charts to ensure correct coding. Train medical staff on coding/billing changes. Maintain the cash receipts log, prepare deposits, complete general ledger entries, and reconciliations. 

Key Job Responsibility Areas 

1. Coding/Auditing
2. Billing Process
3. Payment Processing
4. Credentialing
5. Cash Receipts and G/L application
6. Miscellaneous

Detail of Key Job Responsibility Areas

Coding/Auditing

1. Evaluate medical record documentation and encounter coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflect and support the outpatient visit, and to ensure that data comply with legal standards and guidelines.
2. Interpret medical information such as diseases or symptoms, and diagnostic descriptions and procedures for a given visit in order to accurately assign and sequence the correct ICD 10, CPT codes and HCPCS II.
3. Review Medicaid and Medicare reimbursement claims before submission for completeness and accuracy and to minimize claim denial.
4. Assist staff in making changes to the electronic medical record master file as required.
5. Provide technical guidance to clinical providers and other departmental staff in identifying and resolving issues or errors, such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, or codes that do not conform to approved coding principles/guidelines.
6. Educate and advise staff on proper code selection, documentation, procedures and requirements.
7. Identify training needs, prepare training materials, and conduct training for clinical providers and support staff to improve skills in the collection and coding of quality health data.
8. Measure and report trends in provider coding

  
Billing Process

1. Evaluate encounters for completeness and ability to be billed. 
2. Submit third party claims to payers for processing
3. Work denials and rejections from clearinghouse and payers
4. Resubmit denied claims as necessary
5. Patient contact to resolve billing problem
6. Aggressively follow-up on collection of aged accounts receivable
7. Interact with Case Management staff on insurance problems
8. Compliance activities as directed

Payment Processing

1. Post third party remittances
2. Post payments received on patient and client accounts to eMD’s, Medent and Millin/ AIRS in a timely manner.
3. Work denials and rejections from payers
4. Reconcile industry-specific applications, i.e., eMDs, AIRS, Medent, Scriptpro, TPMS, FundEZ, to general ledger and resolve differences in a timely manner

 
Credentialing

1. Maintain Provider insurance panels and credentialing
2. Assure all payer contracts are up to date and maintained

 
Cash Receipts- Back up for Accounting Team

1. Post cash receipts (electronic) to the general ledger in a timely manner.
2. Prepare Bank Deposit
3. Balance deposits from the Pharmacy and Clinic to the general ledger

Miscellaneous

1. Requires the ability and commitment to respect and support inclusiveness and diversity including but not limited to individuals of different backgrounds, cultures, races, ages, sexual orientations, gender identities or expressions, experiences, opinions, etc.
2. Requires individual demonstration of commitment to the One Trillium behaviors and business impacts and modeling them in the organization.
3. Responsible for maintaining confidentiality of all patient, client, employee, protected and proprietary information.
4. Employees are accountable for meeting the performance standards of their departments and must participate as requested in compliance audits, process improvement and quality improvement plans. 
5. Other duties as assigned.

Qualifications

Associates’ degree in a relevant field plus 5 years’ experience in medical billing/coding. Valid Coding Certification required (CPC, CCS, CMC). Proficiency in Microsoft Excel and Word required. Must have a positive attitude, good attention to detail, be willing to take initiative and exercise good judgment.  Must be reliable, highly organized and able to prioritize and juggle a variety of activities.

Physical Requirements

While performing the duties of this job the employee is required to stand, sit, walk, use hands to finger, handle, or feel; reach with hands and arms, talk and hear. Occasionally the employee must stoop, bend and lift or move up to 25 lbs.  Specific vision abilities required include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus.  

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.