medical billing and coding specialist

ExamWorks

<div>
 
 Exam Works is looking for a Medical Coding Specialist to join our team remotely!
 
 
 
 <ul>
 <li>
 Must possess current coding certification in CPC. CPMA certification &amp; Certified Life Care Planner certification preferred.
 
 
 </li>
 </ul>
 The
 
 Medical Coding Specialist
 
 (Internally called a Coding Specialist) is responsible to create and write reports based on medical records and appropriate guideline criteria. This position utilizes the system database to determine usual and customary and/or state fee schedule allowances and this position is responsible for analyzing provider billing for proper coding and billing guidelines across all provider types and ensures reviews are completed with highest quality and integrity and that all work is in full compliance with client contractual agreements, regulatory agency standards and/or federal and state mandates.
 
 
 Schedule for this role is:
 
 Monday - Friday 8am-5pm EST
 
 
 
 
 Essential Job Functions
 
 
 
 <ul>
 <li>
 Receive and input client and examinee data in the system database.
 </li>
 <li>
 Sort and verify each claim.
 </li>
 <li>
 Process and review each claim and address all necessary modifications manually. Contact Client as needed
 </li>
 <li>
 Perform quality assurance on every case prior to completion.
 </li>
 <li>
 Ensure all medical records and reports are properly documented and saved in the appropriate location and available for audit at all times.
 </li>
 <li>
 Process client invoicing in accordance with the client&rsquo;s fee schedule.
 </li>
 <li>
 Handle and responds promptly to incoming calls, emails or faxes from clients requesting report status and/or information.
 </li>
 <li>
 Provide notification to the Supervisor of any provider appeals and follow directions as given to resolve the claim.
 </li>
 <li>
 Provide testimony in court as to the content of prepared reports, as required. Travel as necessary.
 </li>
 <li>
 Ensure all practices are carried out in accordance with HIPAA compliance practices, state and federal safety standards and legal regulations.
 </li>
 <li>
 Perform quality assurance on various coding related reviews.
 </li>
 <li>
 Perform other duties as assigned.
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 
 Education and/or Experience
 
 
 
 <ul>
 <li>
 High school diploma or equivalent required.
 </li>
 <li>
 Minimum one year medical billing experience; or equivalent combination of education and experience required.
 
 
 </li>
 </ul>
 
 Certificates, Licenses, Registrations
 
 
 
 
 Must Possess Current Coding Certification In
 
 
 
 <ul>
 <li>
 OASIS, RAC-CT, CCS, CPC, RHIT or RHIA. CPMA certification preferred.
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Must have minimum of one year medical billing experience; or equivalent combination of education and experience required.
 </li>
 <li>
 Must have a full understanding of aspects of medical billing.
 </li>
 <li>
 Must demonstrate understanding of the various types of medical billings and ability to identify which system database should be used.
 </li>
 <li>
 Must be able to cross reference different types of billings to ensure consistency in the review process.
 </li>
 <li>
 Must possess knowledge of standard fee schedule review, UC&amp;R review, drug and supply charges, rarity, utilization review, CPT guidelines, ICD 10, bundling/unbundling, duplicate billing and CMS reimbursement guidelines.
 </li>
 <li>
 Must possess complete knowledge of general computer, fax, copier, scanner, and telephone.
 </li>
 <li>
 Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
 </li>
 <li>
 Must have a full understanding of HIPAA regulations and compliance.
 </li>
 <li>
 Must be a qualified typist with a minimum of 35 W.P.M.
 </li>
 <li>
 Ability to follow instructions and respond to managements&rsquo; directions accurately.
 </li>
 <li>
 Ability to work independently, prioritize work activities and use time efficiently.
 </li>
 <li>
 Must be able to maintain confidentiality.
 </li>
 <li>
 Must be able to demonstrate and promote a positive team -oriented environment.
 </li>
 <li>
 Must be able to stay focused and concentrate under normal or heavy distractions.
 </li>
 <li>
 Must be able to work well under pressure and or stressful conditions.
 </li>
 <li>
 Must possess the ability to manage change, delays, or unexpected events appropriately.
 </li>
 <li>
 Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time.
 
 
 </li>
 </ul>
 
 ExamWorks
 
 is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services. Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers' compensation insurance coverages.
 
 
 
 ExamWorks, LLC
 
 is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.
 
 
 
 Equal Opportunity Employer - Minorities/Females/Disabled/Veterans
 
 
 
 
 
 ExamWorks offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.
 
 
 
 
 TAGS
 
 
 CPC, CPMA, Medical Billing, Medical Billing Specialist
</div>

Medical Coding Specialist (32635)

CacheLogic

Job SummaryWe are seeking a detail-oriented and experienced Medical Billing Specialist to manage the end-to-end medical billing process. The ideal candidate should have hands-on experience with US healthcare billing, insurance claims, payment posting, denial management, and revenue cycle management (RCM). The candidate must ensure timely claim submissions, accurate billing, and maximum reimbursement while maintaining compliance with HIPAA and payer guidelines.Key Responsibilities<ul><li>Prepare, review, and submit medical claims to insurance companies.</li><li>Verify patient insurance eligibility and benefits.</li><li>Process electronic and paper claims accurately.</li><li>Follow up on unpaid, denied, or rejected claims.</li><li>Analyze denials and resolve billing issues promptly.</li><li>Post insurance and patient payments accurately.</li><li>Generate patient statements and coordinate collections.</li><li>Review medical documentation for billing accuracy.</li><li>Ensure compliance with HIPAA and insurance regulations.</li><li>Maintain accurate billing records and documentation.</li><li>Coordinate with providers, insurance companies, and patients regarding billing inquiries.</li><li>Meet daily and monthly billing productivity targets.</li><li>Support revenue cycle management (RCM) activities.</li></ul>Required Qualifications<ul><li>Bachelor's degree (preferred).</li><li>2+ years of experience in US Medical Billing.</li><li>Strong understanding of Revenue Cycle Management (RCM).</li><li>Knowledge of ICD-10, CPT, and HCPCS coding.</li><li>Experience with insurance verification and authorization.</li><li>Hands-on experience with claim submission and denial management.</li><li>Familiarity with Medicare, Medicaid, and Commercial Insurance.</li><li>Experience using EMR/EHR and Medical Billing Software.</li><li>Excellent communication and analytical skills.</li><li>Strong attention to detail and problem-solving abilities.</li></ul>Preferred Skills<ul><li>AR Follow-up</li><li>Payment Posting</li><li>Charge Entry</li><li>Eligibility Verification</li><li>Claims Processing</li><li>Denial Management</li><li>Medical Coding Knowledge</li><li>HIPAA Compliance</li><li>Revenue Cycle Optimization</li><li>Excel and Reporting</li></ul>Job Type: Full-timeApplication Question(s):<ul><li>Current Salary?</li><li>Expected salary?</li><li>This is onsite role are you comfortable? </li><li>Office time is night shift are you ok with it?</li></ul>Work Location: In person

Medical Billing Executive / Medical Billing Specialist

Neighborhood Health Clinics Inc

<div>PATIENT ACCOUNT CODING SPECIALIST
At Neighborhood Health, we&rsquo;re passionate about our mission to provide a kind and caring premiere workforce. Our team-based approach to comprehensive patient care creates a challenging and rewarding work environment where you have a direct role in helping members of our community receive quality medical services they can afford. And, that&rsquo;s something you can feel good about. As a member of our growing team, you will feel at home in a fun and diverse community of healthcare professionals.
As a member of our growing team, you will feel at home in a fun and diverse community of healthcare professionals. Our goal is simple: improving access to healthcare in our community and surrounding areas. Together, we are all committed to building healthier communities by delivering comprehensive, quality health care with compassion and respect.
SUPERVISORY RESPONSIBILITIES
None
ESSENTIAL DUTIES &amp; RESPONSIBILITIES
Patient Account Coding Specialist I<ul><li>
Examines documents for missing information; corrects information as needed.</li><li>
Maintains practice management system by entering accurate data, verifying and</li></ul>
updating insurance and claims information.<ul><li>
Prepare, review, submit, investigate rejected claims, and follow up with clean claims to various</li></ul>
companies/individuals<ul><li>
Performs data entry of Labcorp invoices and optometry Medicaid waiver charges.</li><li>
Participates in professional development activities. Serves on committees as requested.</li></ul><ul><li>
Performs duties following NHC Standards of Conduct and Mission Statement.</li><li>
Performs related work as required and other duties (similar physical requirements and OSHA risk level) as assigned.</li></ul>
Patient Account Coding Specialist II
All duties listed under the Patient Account Coding Specialist I with additional duties:<ul><li>
Extracts relevant information from patient records and acts as a liaison with providers and other parties to clarify information.</li><li>
Assigns CPT, HCPCS, ICD-10-CM, and DRG codes</li><li>
Performs patient chart audits and provides coding feedback and education to clinical team as needed</li><li>
Answers questions, advises, and trains providers and staff on medical coding</li></ul>
REQUIRED SKILLS / ABILITIES<ul><li>
Medical Office-demonstrates a working knowledge of medical and/or dental office coding procedures, diagnosis coding, and maintains knowledge of, and acts following, current NHC policies and procedures.</li><li>
Problem-solving&mdash;identifies and resolves problems promptly and gathers and analyzes information skillfully.</li><li>
Interpersonal skills&mdash;maintains confidentiality, remains open to others&rsquo; ideas, and exhibits willingness to try new things; maintains friendly and supportive relationships with coworkers.</li><li>
Oral communication&mdash;speaks clearly and persuasively in positive or negative situations and demonstrates group presentation skills.</li><li>
Written communication&mdash;edits work for spelling and grammar, presents numerical data effectively, and can read and interpret written information.</li><li>
Planning/organizing&mdash;prioritizes and plans work activities and uses time efficiently.</li><li>
Quality control&mdash;understands the importance of compliance standards and pays close attention to accuracy and detail when performing duties; demonstrates a working knowledge of how grant requirements and federal/state laws impact the day-to-day operations of NHCI&rsquo;s financial department.</li><li>
Adaptability&mdash;adapts to changes in the work environment, manages competing demands, and can deal with frequent change, delays, or unexpected events.</li><li>
Dependability&mdash;consistently at work and on time, follows instructions, responds to management direction, and solicits feedback to improve performance.</li><li>
Safety and security&mdash;actively promotes and personally observes safety and security procedures and uses equipment and materials properly.</li><li>
Computer &amp; Math&mdash;proficient in Microsoft Word, Outlook, and Excel; proficient in basic math to make simple calculations; proficient in the use of practice management software to perform duties efficiently and accurately.</li></ul>
REQUIRED QUALIFICATIONS:
Education / Training
Patient Account Coding Specialist I
High School diploma or GED. Specialized training in medical and/or dental coding/billing preferred.
Patient Account Coding Specialist II
Must complete a professional coding certification program.
Experience
Patient Account Coding Specialist I
One year medical coding or dental coding preferred. Experience with collections and medical office software is preferred. 95% accuracy must be achieved.
Patient Account Coding Specialist II
Two years of medical coding or dental coding required. Experience with collections and medical office software is required. 95% accuracy must be achieved.
Licensure/Certification
Patient Account Coding Specialist I
CPC-A, CPC, CCA or CCS, or must successfully complete within one year of hire.
Patient Account Coding Specialist II
AAPC CPC coding or AHIMA coding certification is required.
Physical Requirements
Prolonged sitting, infrequent to occasional walking or standing. Requires the ability to lift and carry items weighing up to 10 pounds. Requires eye-hand coordination and manual dexterity sufficient to operate office and related electronic equipment. Requires corrected vision and hearing to normal range to record, prepare, and communicate appropriate reports. Requires ability to work under stressful conditions.
Work Environment
Normal clinic office environment. Work may involve irregular hours, including evenings or weekends. Involves frequent contact with other staff and the public. Contact may involve dealing with angry or upset people. Interaction with others is constant and interruptive. OSHA Category III - Tasks do not involve contact with blood or body substances and the performance of Category I or II tasks is not a condition of employment.
Neighborhood Health is an Equal Opportunity Employer. Neighborhood Health does not exclude people or treat them differently for any aspect of the organization because of race, color, national origin, age, disability (physical or mental), or sex (including sexual orientation).
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.</div>

Patient Account Coding Specialist

MarinHealth

<div>
 
 About Marinhealth
 
 
 
 Are you looking for a place where you are empowered to bring innovation to reality? Join MarinHealth, an integrated, independent healthcare system with deep roots throughout the North Bay. With a world-class physician and clinical team, an affiliation with UCSF Health, an ever-expanding network of clinics, and a new state-of-the-art hospital, MarinHealth is growing quickly. MarinHealth comprises MarinHealth Medical Center, a 327-bed hospital in Greenbrae, and 55 primary care and specialty clinics in Marin, Sonoma, and Napa Counties. We attract healthcare&rsquo;s most talented trailblazers who appreciate having the best of both worlds: the pioneering medicine of an academic medical center combined with an independent hospital's personalized, caring touch.
 
 
 MarinHealth is already realizing the benefits of impressive growth and has consistently earned high praise and accolades, including being Named One of the Top 250 Hospitals Nationwide by Healthgrades, receiving a 5-star Ranking for Overall Hospital Quality from the Centers for Medicare and Medicaid Services, and being named the Best Hospital in San Francisco/Marin by Bay Area Parent, among others.
 
 
 
 Company
 
 
 
 Prima Medical Foundation dba MarinHealth Medical Network
 
 
 
 Work Shift
 
 
 
 8 Hour (days) (United States of America)
 
 
 
 Scheduled Weekly Hours
 
 
 
 40
 
 
 
 Job Description Summary
 
 
 
 The Billing Specialist is responsible for the coordination of full-scope for each assigned specialty. In conjunction with Practice Leaders ensures accurate charge capture and management of the reconciliation process. Daily review and working of revenue cycle work queues is essential. Communicates with coding vendor regarding surgical procedures. Trains support staff on appropriate billing procedures. Works with Revenue Cycle and Operation Directors on overall status of outstanding billing for these specialties.
 
 
 
 Pay Range
 
 
 
 
 Job Requirements, Prerequisites and Essential Functions:
 
 
 
 $23.00 - $27.40 - $31.73
 
 
 
 Essential Functions And Responsibilities
 
 
 
 <ul>
 <li>
 Effectively uses application of &ldquo;Current Procedural Terminology&rdquo; (CPT) coding system; interprets appropriately and accurately.
 </li>
 <li>
 Ensures clinical staff and providers submit proper and accurate documentation for the services being provided.
 </li>
 <li>
 Serves as a liaison/resource for clinical and non-clinical staff regarding revenue cycle processes.
 </li>
 <li>
 Responsible for completion of all claims and itemized bills daily, with complete accuracy.
 </li>
 <li>
 Responsible for the daily review of appropriate reports from Apex and reporting any discrepancies to the Practice Leader.
 </li>
 <li>
 Performs quality control functions on claims and itemized bills to ensure overall accuracy to assure prompt and correct payments.
 </li>
 <li>
 Fosters effective working relationships with external organizations and agencies as required.
 </li>
 <li>
 Responsible for maintaining a strong focus on assigned tasks and at all times being a strong team player.
 </li>
 <li>
 Ability to exercise initiative, decision-making, and problem solving.
 </li>
 <li>
 Ability to manage multiple tasks in a busy clinical environment.
 </li>
 <li>
 Ability to prioritize tasks and manage time efficiently.
 </li>
 <li>
 Other duties as assigned
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Strong interpersonal skills with ability to communicate in a clear and positive manner both verbally and in writing.
 </li>
 <li>
 Ability to read, understand, and follow oral and written instruction with attention to detail required.
 </li>
 <li>
 Ability to problem solve and monitor / track data, identify trends and create solutions.
 </li>
 <li>
 Understanding of insurance payors, prior authorizations and eligibility requirements.
 </li>
 <li>
 Knowledge of computer systems and applications, i.e. Microsoft Office, Excel, Word.
 
 
 </li>
 </ul>
 
 Licensure
 
 
 
 <ul>
 <li>
 Coding specialist certification preferred.
 
 
 </li>
 </ul>
 
 Education
 
 
 
 <ul>
 <li>
 High school diploma or General Education Degree (GED) required.
 
 
 </li>
 </ul>
 
 Experience
 
 
 
 <ul>
 <li>
 Minimum 3 years&rsquo; experience in medical billing.
 </li>
 <li>
 Experience in health care customer service.
 </li>
 <li>
 Experience with Apex/Epic preferred.
 </li>
 <li>
 Experience and current knowledge of ICD10CM, CPT, and HCPCS coding methods. Coding experience a plus.
 
 
 </li>
 </ul>
 
 Accommodation
 
 
 
 Qualified applicants with disabilities may request reasonable accommodation during the application process by contacting Human Resources at 415-925-7040 or TalentAcquisition@mymarinhealth.org.
 
 
 
 C.A.R.E.S. Standards
 
 
 
 MarinHealth seeks candidates ready to model our C.A.R.E.S. standards&mdash;Communication, Accountability, Respect, Excellence, Safety&mdash;which foster a healing, trust-based environment for patients and colleagues.
 
 
 
 Health &amp; Immunizations
 
 
 
 To protect employees, patients, and our community, MarinHealth requires measles, mumps, varicella, and annual influenza immunizations as a condition of employment (and annually thereafter). COVID-19 vaccination/booster remains strongly recommended. Medical or religious exemptions will be considered consistent with applicable law.
 
 
 
 Compensation
 
 
 
 The posted pay range complies with applicable law and reflects what we reasonably expect to pay for this role. Individual pay is set by skills, experience, qualifications, and internal/market equity, consistent with MarinHealth&rsquo;s compensation philosophy. Positions covered by collective bargaining agreements are governed by those agreements.
 
 
 
 Equal Employment
 
 
 
 All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, sexual orientation, gender identity, protected veteran status or disability status, and any other classifications protected by federal, state, and local laws.
</div>

Medical Billing Specialist, Orthopedics, (Novato), Full-Time, Days

Contentnea Health

<div>Company Overview
Contentnea Health is a Community Health Center providing comprehensive medical, dental and behavioral health services for members of our communities in Greene, Pitt and Pamlico counties in eastern North Carolina.
Job Summary
Submits healthcare claims accurately and efficiently, including researching and correcting denials and errors, applying discounts and adjustments, and resubmitting claims as needed to ensure timely payment.
Responsibilities and Duties<ul><li>
Performs billing and collection activities for medical, behavioral health and dental services.
<ul><li>Creates claims submissions for assigned payers and/or patient accounts.
</li><li>Corrects and resubmits rejected claims for assigned payers and/or patient accounts.</li><li>
Researches, corrects and resubmits denied claims for assigned payers and/or patient accounts.</li><li>
Follows-up with payers via the most effective channel (payer portals, email, phone) to resolve outstanding claims including filing appeals and reconsideration requests.
</li><li>Identifies credit balances for assigned payers and/or patient accounts, researches and verifies accuracy of credit balance and submits refund requests as appropriate.
</li><li>Identifies account balances meeting the criteria for bad debt write-off, researches and verifies accuracy of balance and flags balances as appropriate to be written off as bad debt.</li><li>
Posts third party payments for assigned payers and/or patient accounts accurately to charges.
</li><li>Reviews account balances for patients qualified for the Sliding Fee Discount Program and applies discounts to eligible patient charges.</li><li>
Performs work in accordance with departmental timelines for claims creation, submission, resolution of claim rejections and denials and open/unpaid claims.</li><li>
Assists with reconciliation of patient and payer payments as requested.</li><li>
Communicates with credentialing staff and/or external credentialing vendor as needed to ensure necessary enrollments and/or updates are performed to mitigate claims denials.</li><li>
Maintains all documents relevant to daily billing functions in internal data repository, e.g. remittance advices, payer correspondence, fee schedule, billing/coding rules, W9 forms, memos, charge slips, training documents etc.</li></ul></li><li>
Provides customer service to internal and external customers.
<ul><li>Acknowledges, researches, and resolves patient inquiries related to billing and financial counseling functions.
</li><li>Provides written notification to supervisor of all patient complaints regarding billing and collections.
</li><li>Responds to staff inquiries regarding patient billing and collections.</li></ul></li></ul>
Qualifications and Skills
Possesses specific knowledge and training in billing processes and practices, typically acquired during completion of a certificate program in billing practices with a duration of up to a year. Possesses a basic knowledge of medical terminology, procedural and diagnostic coding, medical-dental cross-coding, electronic claims processing and of insurance policies and contracts for multiple insurance vendors. Current certification as a Community Health Coding and Billing Specialist (CH-CBS).
MDE9rai2Eb</div>

Billing and Collections Representative

Appalachian Regional Healthcare

<div>Overview:
<div>
Under general supervision, the Clinic Billing and Follow-Up Specialist handles essential billing and insurance follow-up functions. This role requires a fundamental understanding of insurance claim processing, knowledge of HCFA claim forms, and the ability to interpret insurance explanation of benefits (EOBs), handle denials, and perform follow-up with insurers to ensure claims resolution. The position encompasses business office responsibilities related to patient accounts, including charge import, appeals, diagnostics and procedural coding, and claim follow-up with third-party payers to achieve a zero-balance resolution.</div>
Special Instructions: Position is On-Site with Hybrid work option after at least six months Responsibilities:
<ul><li>Promote the mission, vision, and values of the organization</li><li>
Import charges from queues in a timely manner and append modifiers or any required information for claim transmission</li><li>
 Review daily accounts that are ready to be billed in Waystar from Meditech</li><li>
 Initiate correction on all claims with errors by the designated time</li><li>
Follow up on any correspondence that may have been received on that day or the previous day</li><li>
 Cross train on billing all lines of business to the different payers</li><li>
 Pull listing of all accounts assigned to be follow up by specific payer</li><li>
 Diagnostic and procedural coding</li></ul><div>
Follow-Up Responsibilities</div><ul><li>
Responsible for the resubmission of primary, secondary, and tertiary claims per respective regulations and policies.</li><li>
Communicate with third-party representatives as necessary to complete claims processing and /or resolve problem claims.</li><li>
Follow-up daily on post processing activity including but not limited to, rejected billings, adjustments, and rebilling, and denied claims for accounts.</li><li>
Maintain accounts receivable detail of their accounts through tasking.</li><li>
Maintains standards per payer for percentage accounts &gt;90 days.</li><li>
Works minimum standard number of accounts per payer per day.</li><li>
Meets or exceeds collection goals by payer each month.</li><li>
Works all assigned accounts as assigned, depending on balance.</li><li>
Complete appeals as required.</li><li>
Participates in educational activities and attends monthly department staff meetings.</li><li>
Maintains confidentiality: adheres to all HIPAA guidelines/regulations.</li><li>
Other duties as assigned from time to time.</li><li>
Attend educational activities and monthly department staff meetings</li><li>
Perform other duties as assigned</li></ul>
Qualifications:
<div><div><ul><li>High School Diploma or GED</li></ul></div><div></div><div><div> 
<ul><li>
Six months previous experience in clinic registration, billing and collections, financial counseling, or customer service preferred</li></ul></div></div><div></div><div><div> 
<ul><li>
Knowledge of medical terminology preferred</li></ul><ul><li>
Basic computer proficiency</li></ul><ul><li>
Typing speed: minimum 40 WPM</li></ul><ul><li>
Familiarity with CPT and ICD-9 coding is helpful</li></ul><ul><li>
Good written and verbal communication skills are essential for account follow-up</li></ul></div></div></div></div><div></div>

Clinic Billing Specialist

Beth Israel Lahey Health

<div>
 
 When you join the growing BILH team, you're not just taking a job, you&rsquo;re making a difference in people&rsquo;s lives.
 
 
 
 Identifies, reviews, and interprets third party payments, adjustments and coding denials for all professional services. Reviews provider documentation in order to determine appropriate coding and initiate corrected claims and appeals. Duties include hands on coding, documentation review and other coding needs for ICD-9, ICD-10. Works directly with the Billing Supervisor and Coding Manager to resolve complex issues and denials through independent research and assigned projects. (remote)
 
 
 
 Job Description
 
 
 
 
 Essential Duties &amp; Responsibilities
 
 including but not limited to:
 
 
 
 Coding Responsibilities
 
 
 
 <ul>
 <li>
 Provides review and/or coding of any coding related denied professional services for appropriate use of CPT, ICD-9, ICD-10, HCPCS, Modifier usage/linkage.
 </li>
 <li>
 Periodic review of codes, at least annually or as introduced or required.
 </li>
 <li>
 Reviews and analyzes rejected claims and patient inquiries of professional services, and recommends appropriate coding corrections via paper or electronic submission to the Follow up Team.
 </li>
 <li>
 Reports coding trends and issues to the coding supervisor for education within the coding department and/or physician education.
 </li>
 <li>
 Confers regularly with the Coding Department through regular departmental staff meetings, on-on-one meetings to review and discuss coding denials and education.
 </li>
 <li>
 Maintains certification requirements for coding.
 
 
 </li>
 </ul>
 
 Follow Up Responsibilities
 
 
 
 <ul>
 <li>
 Monitors days in A/R and ensures that they are maintained at the levels expected by management. Analyzes work queues and other system reports and identifies denial/non-payment trends and reports them to the Billing Supervisor.
 </li>
 <li>
 Responds to incoming insurance/office calls with professionalism and helps to resolve callers&rsquo; issues, retrieving critical information that impacts the resolution of current or potential future claims.
 </li>
 <li>
 Establishes relationships and maintains open communication with third party payor representatives in order to resolve claims issues.
 </li>
 <li>
 Reviews claim forms for the accuracy of procedures, diagnoses, demographic and insurance information, as well as all other fields on the CMS 1500.
 </li>
 <li>
 Reviews and corrects all claims/charge denials and edits that are communicated via Epic, Explanation of Benefits (EOB), direct correspondence from the insurance carrier or others and uses information learned to educate PFS and office staff to reduce future denials and edits of the same nature. Initiates claim rebilling or corrections and obtains and submits information necessary to ensure account resolution/payments.
 </li>
 <li>
 Identifies invalid account information (i.e.: coverage, demographics, etc.) and resolves issues.
 </li>
 <li>
 Evaluates delinquent third party accounts and processes based on established protocols for review, payment plan or write-off.
 </li>
 <li>
 Reviews/updates all accounts for write-offs and refunds.
 </li>
 <li>
 Keeps informed of all federal, state, and managed care contract regulations, maintains working knowledge of billing mechanics in order to properly ascertain patients&rsquo; portion due.
 </li>
 <li>
 Completes all assignments per the turnaround standards. Reports unfinished assignments to the Billing Supervisor.
 </li>
 <li>
 Handles incoming department mail as assigned.
 </li>
 <li>
 Attends meetings and serves on committees as requested.
 </li>
 <li>
 Maintains appropriate audit results or achieves exemplary audit results. Meet productivity standards or consistently exceeds productivity standards.
 </li>
 <li>
 Provides and promotes ideas geared toward process improvements within the Central Billing Office.
 </li>
 <li>
 Assists the Billing Supervisor with the resolution of complex claims issues, denials and appeals.
 </li>
 <li>
 Completes projects and research as assigned.
 </li>
 <li>
 Provides feedback and participates as the coding representative for the Patient Financial Services Department on the Revenue Cycle teams.
 
 
 </li>
 </ul>
 
 Secondary Functions
 
 
 
 <ul>
 <li>
 Enhances professional growth and development through in-service meetings, education programs, conferences, etc.
 </li>
 <li>
 Complies with policies and procedures as they relate to the job. Ensures confidentiality of patient, budget, legal and company matters.
 </li>
 <li>
 Exercises care in the operation and use of equipment and reference materials. Performs routine cleaning and preventive maintenance to ensure continued functioning of equipment. Maintains work area in a clean and organized manner.
 </li>
 <li>
 Refers complex or sensitive issues to the attention of the Billing Supervisor to ensure corrective measures are taken in a timely fashion.
 </li>
 <li>
 Observes irregularities in the cash/denial posting process and reports them immediately to the Billing Supervisor.
 </li>
 <li>
 Accepts and learns new tasks as required and demonstrates a willingness to work where needed.
 </li>
 <li>
 Assists other staff as required in the completion of daily tasks or special projects to support the department&rsquo;s efficiency.
 </li>
 <li>
 Performs similar or related duties as assigned or directed.
 
 
 </li>
 </ul>
 
 Education &amp; Professional Development
 
 
 
 <ul>
 <li>
 Researches and stays updated and current on CMS (HCFA), AMA and Local Coverage Determinations (LCD&rsquo;s), or Local Medical Review Policies (LMRP's) to ensure compliance with coding guidelines.
 </li>
 <li>
 Stays current on quarterly CCI Edits, bi-monthly Medicare Bulletins, Medicare's yearly fee schedule, Medicare Website, and specialty newsletters.
 </li>
 <li>
 Makes guidelines available via, paper, on-line access, web access, or any other means provided by manager.
 
 
 </li>
 </ul>
 
 Organizational Requirements
 
 
 
 <ul>
 <li>
 Maintain strict adherence to the Lahey Health Confidentiality policy.
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 Incorporate Lahey Health Standards of Behavior and Guiding Principles into daily activities.
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 Comply with all Lahey Health Policies.
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 Comply with behavioral expectations of the department and Lahey Health.
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 Maintain courteous and effective interactions with colleagues and patients.
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 Demonstrate an understanding of the job description, performance expectations, and competency assessment.
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 Demonstrate a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.
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 Participate in departmental and/or interdepartmental quality improvement activities.
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 Participate in and successfully completes Mandatory Education.
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 Perform all other duties as needed or directed to meet the needs of the department.
 
 
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 </ul>
 
 Minimum Qualifications
 
 
 
 Education: High School diploma or equivalent, plus additional specialized training associated attainment of a recognized Coding Certificate
 
 
 Licensure, Certification &amp; Registration: CP (Certified Professional Coder through AAPC), CPC-A (Certified Professional Coder - Apprentice through AAPC), or CCS-P (Certified Coding Specialist Physician Based through AHIMA)
 
 
 Experience: 1-2 years of experience in billing, coding, denial management environment related field.
 
 
 
 Skills, Knowledge &amp; Abilities
 
 
 
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 Ability to work independently and take initiative
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 Good judgment and problem solving skills
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 Excellent organizational skills
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 Ability to interact and collaborate effectively and tactfully with staff, peers and management.
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 Ability to promote team work through support and communication.
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 Ability to accept constructive feedback and initiate appropriate actions to correct situations.
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 Ability to work with frequent interruptions and respond appropriately to unexpected situations.
 
 
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 </ul>
 
 Pay Range
 
 
 
 $25.00 - $34.00
 
 
 The pay range listed for this position is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law. Compensation may exceed the base hourly rate depending on shift differentials, call pay, premium pay, overtime pay, and other additional pay practices, as applicable to the position and in accordance with the law.
 
 
 As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment.
 
 
 More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.
 
 
 Equal Opportunity Employer/Veterans/Disabled
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Billing & Certified Coding Specialist I (Remote)

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