Billing Coding Specialist

Description

The Billing Coding Specialist is primarily responsible for the coding/billing and resolution of denied claims. 

Essential Duties: 

Duties include, but are not limited to: 

• Code claims according to coding and billing guidelines. 

• Bill claims in accordance with payor guidelines. 

• Investigate payer- rejected claims to determine reason for denial and work to obtain resolution. 

• Prioritize and work HOLD an MGR HOLD buckets. 

• Verify patient insurance coverage and eligibility. 

• Update patient records with accurate insurance information. 

• Manage accounts receivable and follow up on overdue payments. 

• Collaborate with other departments, such as medical coding and front office, to ensure accurate and timely processes. 

• Support the revenue cycle by ensuring clai8ms are dropped within 2 days of current date. 

• Assist in general administrative tasks as needed. 

• Review all claims returned for Medical Necessity and correct if able; report findings to Team Lead. 

• Follows established departmental policies, procedures, and objectives, continuous quality improvement objectives, and safety and environmental standards. 

• Attends coding conferences, workshops, and in-house sessions to receive updated coding information and changes in coding and/or regulations. 

• Performs other duties as required. 

• Other Duties as presented by supervisor and/or Directors. 

Qualifications

Qualifications: 

Basic Knowledge and Skills: 

• Must be (at least) 21 years old. 

• Solid understanding of billing software and electronic medical records.  

• Understanding of relevant laws and best practices as it relates to Medicare and Medicaid billing. 

• Ability to problem solve and develop solutions. 

• Understanding of HIPAA regulations and medical terminology. 

• High school diploma required. 

• Experience with Excel required. 

• Prefer experience with Athena system. 

• Current certification as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS). 

• 1 or more years’ experience as an outpatient coder. 

• Minimum of 3 years’ experience with claims billing. 

Physical and Mental Requirements: 

• Position requires extended periods of sitting and standing including bending and reaching. 

• Handles stress in a positive manner. 

• Ability to be flexible and to multitask. 

• Demonstrated interest in working with an underserved population. 

We are an equal-opportunity employer. All resumes will be reviewed for education and experience. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status, or any other legally protected status.