Certified
Billing and Coding Specialist
Job
Code: BCSPEC - 111
Revision Date: November 9, 2022
Starting
Salary:
$18.59 hourly; $38,672 annually
FLSA: Exempt
Overview
We are an agency committed to
innovative behavioral health services in trauma-informed care that promote
healing and recovery to instill a sense of empowerment and foster a lifelong
sense of resilience.
General Description
The purpose of this job is responsible
for auditing progress notes, billing for services, appeal denied claims,
verifying eligibility, submit referrals/authorization and post payments for all
outpatient medical/substance abuse accounts for various providers. Billing and
Coding Specialist will assist Revenue Cycle team with coding questions and/
special projects.
This class works under close to
general supervision according to set procedures but determines how or when to
complete tasks.
Duties and Responsibilities
The functions listed below are those
that represent the majority of the time spent working in this position.
Management may assign additional functions related to the type of work of the
position as necessary.
- Maintain a Coding accuracy rate at or above 95%.
- Apply all coding rules and use of CPT codes and ICD-10
codes and appropriate use of modifiers.
- Responsible for making sure all claims have appropriate
documentation before being coded and claims submitted, reviewing accounts
for insurance of patient follow-up.
- Audit medical notes and superbills for accuracy in CPT,
HCPCS, ICD-10 Coding.
- Filing medical/behavioral health claims, in timely
manner.
- Checking each insurance payment for accuracy and
compliance with contract discount.
- Calling insurance companies regarding any discrepancy
in payments if necessary.
- Identifying and billing secondary or tertiary
insurances.
- Researching and appealing denied claims.
- Answering all patient or insurance telephone inquiries
pertaining to assigned accounts.
- Setting up patient payment plans and work collection
accounts.
- Updating billing software with rate changes.
- Updating cash spreadsheets and running collection
reports.
- Investigate and analysis all client accounts for
collection of overdue balances.
- Assist department with research of claims not paid
and/or denying.
- Provides service of the highest quality in a
professional and courteous manner to all referral sources and patients.
- Coordination of timely collection of amounts pass due
to achieve practice aging goals/monthly collection goals.
- Daily reconcile of billing and reimbursements.
- Develop implement and consistently seek improvement in
policies and procedures for all billing and reimbursement functions.
- Assist in providing educational tools to providers.
- Assist all staff with coding as required.
- Constant review and recommended updates on coding
changes.
- Assist in conducting internal audits for PC, MAT and BH
services of patient charges and corresponding documentation.
Interprets coding guidelines for accurate code assignment.
- Identifies the importance of documentation on code
assignment and the subsequent reimbursement impact.
- Collects, posts, and manages patient account payments.
- Ensures healthcare facilities are reimbursed for all
procedures.
- Performs other duties as assigned.
Minimum Education and Experience
Requirements
Requires an Associate's degree
supplemented by two (2) years of medical coding experience; or possession of
any equivalent combination of education, training, and experience which
provides the requisite knowledge, skills, and abilities.
Experience with trauma-informed
services; cognitive behavioral therapies, including Dialectical Behavioral
Therapy (DBT); and motivational therapies including the use of incentives,
preferred.
Required Knowledge and Abilities
Knowledge of trauma-informed
theories, principals, and practices (includes multi-faceted understanding of
concepts such as community trauma, intergenerational and historical trauma,
parallel processes, and universal precautions), preferred.
Physical Demands
Performs sedentary work that
involves walking or standing some of the time and involves exerting up to 10
pounds of force on a regular and recurring basis or sustained keyboard
operations.
Unavoidable Hazards (Work
Environment)
- Involves routine and frequent
exposure to:
- Bright/dim light; Dusts and
pollen.
- Other extreme hazards not
listed above.
Special Certifications and Licenses
- Requires Certified Coding
Specialist or Certified Coding Professional certification.
- Must possess and maintain a
valid state Driver's License with an acceptable driving record.
- Must be able to pass a TB,
criminal background and drug screen.
Americans with Disabilities Act
Compliance (ADA)
Emergence Health Network is an Equal
Opportunity Employer. ADA requires Emergence Health Network to provide
reasonable accommodations to qualified persons with disabilities. Prospective
and current employees are encouraged to discuss ADA accommodations with management.
Other Job Characteristics
- Staffing requirements, including criteria that staff
have diverse disciplinary backgrounds, have necessary State required
license and accreditation, and are culturally and linguistically trained
to serve the needs of the clinic's patient population.
- Credentialed, certified, and licensed professionals
with adequate training in person-centered, family centered, trauma
informed, culturally-competent and recovery-oriented care.
Note: This Class Description does not constitute an employment
agreement between the Emergence Health Network and an employee and is subject
to change by the Emergence Health Network as its needs change.