Job Title: Medical Billing and Coding Specialist

Job Status:Full-Time

**COVID-19 VACCINATIONS: Highly recommended for all newly hired employees in Community Health and Resource Center**

Job Summary: Under close supervision, the Medical Billing and Coding Specialist is responsible for processing health insurance claims for services provided at all clinics. Employee is responsible for submitting claims for reimbursement and coach healthcare providers to achieve optimal reimbursements.

Essential Duties and Responsibilities:

• Verify the provider’s determination of services provided and patient diagnoses via office and operative notes
• Enter charges in the billing system and/or reviews
• Maintain complete knowledge and comply with all relevant insurance, CPT coding and diagnosis guidelines, disseminating info to staff and providers as necessary
• Review quarterly provider audits, researching proper coding when necessary and working with coding and compliance as needed
• Create relationships with external organizations that allow for streamlining and quick resolution of billing matters for patients
• Document conversations with insurance companies and patients
• Audit agency reports for procedures with office billing to ensure accuracy of billing to payers
• Audit EMR entries to verify correct insurance and demographic information
• Attend regularly scheduled meetings
• Coordinate and follow through with special projects as assigned
• Create a positive, professional, service-oriented work environment for staff, clients and family members by supporting the ACCESS mission and core values statement
• Use a special coding system to choose diagnosis and procedure codes
• Enter the correct codes into patients’ electronic health records
• Review claims to make sure coding is accurate
• Work with other staff members to ensure accuracy
• Enter insurance claims into specialized billing programs
• Interact with patients when insurance matters need to be clarified
• Follow up with insurers about any late payments
• Track payments to make sure reimbursements are received on time
• Keep in tune with changes and advancements in the field
• May be responsible for credentialing
• Operate standard office equipment and use required software applications
• Perform other duties and responsibilities as assigned

Knowledge, Skills and Abilities:

Knowledge of:

• Billing and managed care department basic services and hours of operation to respond to customer requests accurately
• Medical, including surgical, terminology and procedures at the level needed to perform job responsibilities, including understanding of CPT and ICD-9/ICD-10 coding
• Rules and regulations regarding insurance claim submissions

Skill in:

• Operating standard office equipment and using required software applications for program area and other applications, including Microsoft Office
• Critical thinking with the ability to effectively problem solve (e.g. able to determine if a patient issue requires immediate provider attention if there are significant changes to the patient history or other clinical issues that are presented)
• Strong customer service skills
• Strong multi-tasking skills
• Organizational and time management skills to effectively juggle multiple priorities, time constraints and large volumes of work

Ability to:

• Operate a standard desktop and Windows-based computer system, including but not limited to, electronic medical records, Microsoft Word, Excel, Outlook, intranet and computer navigation
• Use other software as required while performing the essential functions of the job
• Communicate effectively with both written and verbal forms, including proper phone etiquette
• Work collaboratively in a team-oriented environment; courteous and friendly demeanor
• Work effectively with various levels of organizational members and diverse populations including ACCESS staff, patients, family members, insurance carriers, outside customers, vendors and couriers
• Cross-train in other areas of practice in order to achieve smooth flow of all operations
• Exercise sound judgment and problem-solving skills, specifically as it relates to resolving billing and coding problems
• Handle patient and organizational information in a confidential manner
• Work under minimal supervision

Educational/Previous Experience Requirements:

• Minimum Degree Required:

• Associate degree
• Bachelor’s degree preferred

• At least 3-5 years previous clinical billing experience or equivalent combination of education, experience and/or training approved by Human Resources.

Licenses/Certifications:

• Licenses/Certifications Required at Date of Hire:
  • Medical Billing and Coding Certificate or Degree in field, Certified Professional Coder (CPC), Nationally Registered Certified Coding Specialist (NRCCS) or Registered Health Information Technician (RHIT)

Working Conditions:

Hours: Normal business hours, some additional hours may be required

Travel Required: Local travel may be required

Working Environment: Climate controlled office