JOB SUMMARY

The Billing & Coding Specialist in this position will analyze patient accounts and review chart notes, review reports, identify areas of deficiencies and make determinations regarding physician accuracy and education needs. This incumbent will review denial reports to determine reasons and educational needs.

The Billing & Coding Specialist will demonstrate a high level of professionalism, customer service, and interpersonal skills and operates under strict confidentiality guidelines.

DUTIES AND RESPONSIBILITIES

• Maintains current knowledge of the basic and major medical, behavioral health, and prescription coverage plans.
• Maintains current knowledge associated with the billing methodologies of each plan.
• Performs insurance coverage and grant eligibility verifications by making field calls or using other verification tools.

• Compiles billing data from electronic health record system, practice management systems, and other databases.
• Utilizes the encoder or coding books to correctly assign all ICD-10-CM, ICD-10-PCS, and CPT codes for diagnosis and procedures.
• Sequences diagnosis and procedures to generate appropriate ICD-10-CM, CPT, PCS, and DRG codes for billing.
• Queries physicians to obtain clarification or missing elements in the record to be sure of correct coding.
• Utilizes other available resources for assignment of codes as necessary (e.g., Athena, Epic, MIQS, Cardio IMS, Logician, and coding reference materials).
• Demonstrates the ability to interact with others in a way that gives them confidence in one's intentions and those of the organization.
• Completes abstracts for records when appropriate. Checks discharge disposition and attending physician for correctness.
• Provides ICD-10 and CPT codes for Business Services and physician office requests regarding non-billed or non-reimbursed claims.
• Answers inquiries from outpatient clinics and ancillary departments for appropriate assignment of ICD-9-CM and CPT codes.
• Reviews coding denials to ensure coding is accurate per provider documentation.

REQUIREMENTS

• Two (2) years related experience preferably in an acute care hospital setting.
• Knowledge of Athena, Epic or similar software, highly desired.
• Must have paid experience with medical claims coding/billing and medical insurance industry.

EDUCATION

• High School Diploma or GED
• Some College, Associates, or Bachelor’s preferred.

CERTIFICATION, LICENSURE

Required Licenses/Certifications (one of below)

• CCA - Certified Coding Associate by the American Health Information Management Association (AHIMA)
• CCS - Cert-Cert Coding Specialist by the American Health Information Management Association (AHIMA)
• CCS-P - Cert-CCS-P Physician Based by the American Health Information Management Association (AHIMA)
• CIPC - Certified Inpatient Coder by the American Academy of Professional Coders (AAPC)
• COC - Certified Outpatient Coder by the American Academy of Professional Coders (AAPC)
• CPC - Cert-Cert Professional Coder by the American Academy of Professional Coders (AAPC)
• CRC - Cert Risk Adjustment Coder by the American Academy of Professional Coders (AAPC)
• RHIA - Cert-Reg Health Inform. Admins by the American Health Information Management Association (AHIMA)
• RHIT - Cert-Reg Health Inform. TECH by the American Health Information Management Association (AHIMA)

KNOWLEDGE SKILLS & ABILITIES

• Extremely conscientious with excellent organizational skills.
• Capable of working independently and as a team member.
• Must be very customer service oriented.