Ph3Job Type /h3 pFull-time /p h3Billing And Coding Specialist Summary /h3 pResponsible for entering/auditing/coding patient services to ensure encounters transfer properly for submission to insurance payers. Analyze coding related claim issues, process gaps and denials to trend feedback for providers by location and/or specialty. /p h3A Day in the Life /h3 ul liReview provider documentation (including hospital procedures) and translate services into correct codes. Append payer specific modifiers and claim criteria when applicable. /li liReview incomplete encounters and code based on available documentation in EHR systems. /li liKnow and understand several different coding systems, including ICD-10-CM, ICD-10-PCS, CPT, Level 1 HCPCS and Level 2 HCPCS. /li liUse computers / billing software to create and bill encounters that generate clean claims. /li liAttend internal meetings relevant to EHR workflows and share best coding practices. /li liAssist Operations when coding guidance is requested for existing or new services. /li liUnderstand payer reimbursement and PPS visit qualification for Medicare and Medicaid. /li liTrend areas of focus where provider training or re-training is needed. /li liMonitor, trend and resolve tasks related to coding edits, rejections, and denials. /li liCommunicate with providers, patients, and insurance payers. /li liReview patient accounts and correct any missing or inaccurate information. /li liInvestigate and appeal claims that were denied incorrectly. /li liComplete coding projects such as quarterly or ad hoc provider chart audits. /li liAdapt to updates and changes in billing software. /li liAssist with training office staff on billing/coding updates. /li liMaintain strict patient confidentiality and information security. /li liInvestigate insurance fraud and report if found. /li liPerform all other duties and tasks as assigned. /li /ul h3Supervisory Responsibilities /h3 pThis job has no direct reports. /p h3Core Competencies /h3 ul liCustomer Service: Committed to increasing customer satisfaction, sets proper customer expectations, assumes responsibility for solving customer problems, ensures commitments to customers are met. /li liCommunication: Understand and communicate effectively with others using a variety of contexts and formats, which include writing, speaking, reading, listening and interpersonal skills. /li liDependability: Meets commitments, works independently, accepts accountability, handles change, sets personal standards, stays focused under pressure, meets attendance/punctuality requirements. /li liQuality: Is attentive to detail and accuracy, is committed to excellence, looks for improvements continuously, monitors quality levels, finds root cause of quality problems, owns/acts on quality problems. /li liProductivity: Manages a fair workload, volunteers for additional work, prioritizes tasks, develops good work procedures, manages time well, and handles information flow. /li /ul h3Requirements /h3 pTo perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. /p h3Education/Experience /h3 ul liKnowledgeable and experienced with Medical Terminology. /li liMultitask oriented, organizational and team skills. /li liProficiency with computers, Microsoft Office 360 (Outlook, Word Excel), Adobe and medical billing software. /li liKnowledge of unfair debt collection practices and insurance guidelines. /li liUnderstanding of primary code classifications: ICD-10-CM, ICD-10-PCS, CPT and HCPCS. /li liCommunication skills with patients/healthcare companies. /li liBasic accounting and bookkeeping practices. /li /ul h3Language Skills /h3 pAbility to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization. /p h3Reasoning Ability /h3 pAbility to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. /p h3Computer Skills /h3 pTo perform this job successfully, an individual should have the ability to gain knowledge of current practice management system, electronic medical record, Microsoft Word, text paging, Internet, and Intranet. /p h3Certificates, Licenses, Registrations /h3 pCertified Professional Coder (CPC) certificate with some medical billing experience. /p h3Other Applicable Requirements /h3 pAbility to speak Spanish helpful. /p h3Physical Demands /h3 pThe physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is frequently required to stand; walk; use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is occasionally required to sit and stoop, kneel, crouch, or crawl. The employee must regularly lift and /or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus. /p h3Work Environment /h3 pThe work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee are occasionally exposed to fumes or airborne particles; toxic or caustic chemicals and risk of radiation. The noise level in the work environment is usually moderate. /p h3Affirmative Action/EEO Statement /h3 pIt is the policy of Primary Health Solutions to provide equal employment opportunities without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, sexual orientation, genetic information or any other protected characteristic under applicable law. /p h3Other Duties /h3 pPlease note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. /p /p #J-18808-Ljbffr