Medical biller coder job description

• Assist with conversion to new Electronic Medical Record
• Assist clinicians particularly Medical Staff with documenting Evaluation and Management services and Assessments - notifying them if modifications need to be made and following through to ensure all services are documented properly.
• Ability to review and understand all billing requirements for all payers especially Medicare and Medicaid.
• Utilize Microsoft Office applications, databases (particularly Excel and Word) to complete Missing Day Sheet/Unprocessed Events tracking report each week in a timely basis
• Assist with credentialing licensed staff with insurance companies and re-credentialing agency providers numbers with all associated entities
• Create and submit both electronic and paper claims as assigned to all payers.
• Maintain, using Microsoft Office applications (particularly Excel and Word), a variety of analyses and/or summaries of information documenting the NKHS's General Ledger reporting
• Speaking with patients regarding their accounts.
• Assisting with IDDS Waiver Billing/Adjustments and Reconciliation
• Assisting with entry of client financials, following-up on outstanding claims, calling insurance companies and writing letters.
• Prepare, analyze, and work with members of NKHS's billing staff to follow-up on outstanding balances as identified in the monthly detailed A/R aging report
• Develop and maintain computerized spreadsheets use in gathering data to support effective decision-making.
• Complete other business office related assignments as directed by supervisor or his/her designee.
• A/R follow-up/collection calls on any receivable over 150 days

$18.75 per hour plus, depending upon experience

Full time position with exceptional benefits package including low-cost medical and dental, short-/long-term disability coverages, 403(b) retirement plan, life insurance, AFLAC, employee assistance program, generous paid time off, long-term care plan, and additional optional benefits.

Coord, Billing and Coding
Department: Cancer Center

Purpose: Responsible for day-to-day administrative functions not limited to: business operations, patient billing, prescription card through-put, accounting functions and medical record maintenance. Primary responsibility for the enrollment of infusion patients into a prescription card program. This includes but is not limited to: personal one-on-one application completion, submission of applications and claims to drug companies and tracking patient encounters for qualifying events. Will assist with obtaining and documenting patients' insurance coverage and precertification or authorization requirements. Will assist with collection of co-payments and deductibles, conduct follow-up on accounts, as well as verify and document insurance coverage for patients served through the service to include the charge masters. Will assist with follow-up of any/all billing inquiries in conjunction with the GHS Financial Services Department(s). Will have knowledge of medical record documentation to support accurate coding, billing and compliance by external regulatory agencies. Will ensure all activities support the philosophies and standards of Genesis Health System with respect to all applicable pillars.

Report To: Manager, Cancer Center

Supervisory Responsibility: Guidance: The job requires the provision of occasional guidance and training to others. The job does not have formal or official supervisory responsibilities.

Materials Responsibility: Very Limited. Work requires very limited responsibility for material resources. Examples of resources could include personal work materials, supplies or equipment, or very small amounts of cash. The employee has a very limited or indirect amount of control over these resources. Although human error might require the repair or replacement of materials, usually the cost of correcting these errors is minor. The variety and volume of resources is also very limited. Problems associated with material resources are very uncomplicated.

Key Relationship: Co-workers/Health System Employees, Governing Boards, Physicians/Medical Office Staff, Third Party Payors/Insurance Companies.

POSITION SPECIFICATION

Education: 2 year college program or equivalent experience

Field Of Study: Business, Finance, or related field

Special Training: Experience with and knowledge of but not limited to: Billing, A/R, insurance verification, ICD and CPT coding, revenue cycle, and charge capture. Medical terminology knowledge.

Training Preferred: Coding experience. Knowledge of and experience using local/national coverage determinations.

Experience: More than 2 years experience required.

Interpersonal Skills: Interaction is with a variety of people inside or outside the organization. Communications are of moderate difficulty and sensitivity. Contact with others may involve detailed & lengthy dialogues & exchanges of information. Requires a moderate amount of interpersonal skills. Interactions involve dealing with moderately complicated problem situations or stressful encounters.

Working Conditions: There is very limited exposure to adverse environmental conditions. Some undesirable or unpleasant environmental characteristics may occur but the physical environment is generally safe and there is minimal health risk. No safety equipment or unusual precautions are required. The amount of time the employee may experience these minor adverse conditions would be limited to 10% or less of the work day.

Possible Exposure to Blood Borne Pathogens: None

Work Remote in Illinois, Iowa, Indiana, Wisconsin, and Missouri

The Coding Specialist II reflects the mission, vision, and values of NM, adheres to the organization's Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

The PB Coding Specialist II performs Current Procedural Terminology (CPT) and International Classification of Diseases, volume 10 (ICD10) coding through abstraction of the medical record with a focus on more complex encounters and/or has expertise with HCPCs procedural codes. This position has deep understanding of disease process, A&P and pharmacology and acts as a key collaborator with Providers and Clinical areas to ensure the medical record accurately reflects the patient's service. This position trains physicians and other staff regarding documentation, billing and coding, and performs various administrative and clerical duties to support the roles core function. The Coding Specialist II also demonstrates expertise to resolve Optum coding edits.

Responsibilities:

Utilizes technical coding expertise to reviews the medical record thoroughly, utilizing all available documentation abstract and code physician professional services and diagnosis codes (including anesthesia encounters, operative room and surgical procedural services, invasive procedures and/or drug infusion encounters). Additionally, may include coding for Evaluation and Management services, bedside procedures and diagnostic tests as needed.

Follows Official Guidelines and rules in order to assign appropriate CPT, ICD10 codes and modifiers with a minimum of 95% accuracy.

Ensures charges are captured by performing various reconciliations (procedure schedules, OR logs and clinical system reports)

Provides documentation feedback to physicians

Maintains coding reference information

Trains physicians and other staff regarding documentation, billing and coding.

Reviews and communicates new or revised billing and coding guidelines and information

Attends meetings and educational roundtables, communicates pertinent information to physicians and staff.

Resolves pre-accounts receivable edits. Identifies repetitive documentation problems as well as system issues.

Makes appropriate changes to incorrectly billed services, adds missing unbilled services, provides missing data as appropriate, corrects CPT and ICD9 codes and modifiers. Adds MBO tracking codes as needed.

Collaborate with Patient Accounting, PB Billing, and other operational areas to provide coding reimbursement expertise; helps identify and resolve incorrect claim issues and is responsible for drafting letters in order to coordinate appeals

Acts as key point person for Revenue Cycle staff and Account Inquiry Unit staff in obtaining documentation (notes, operative reports, drug treatment plans, etc.). Provides additional code and modifier information to assist with appealing denials. May contact providers for peer-to-peer reviews.

Meets established minimum coding productivity and quality standards for each encounter type

May perform other duties as assigned.