Billing Specialist - Senior (Multiple Positions)

Responsible for office, out-patient, and inpatient physician coding. Provides education regarding documentation requirements to improve coding quality and ensure accurate and complete capture of revenue.

*Responsibilities

1. Implements and manages outpatient and provider coding process for inpatient and outpatient physician services.

2. Validates and determines appropriate coding levels by obtaining and reviewing clinical documentation.

3. Compares and reviews charge tickets, both manually and system generated, to clinical documentation to ensure that all charges for procedures and related services have been accurately documented and captured.

4. Ensures that documentation supports charges to prevent denials/underpayments and to ensure adherence to compliance standards.

5. Follow-up on missing charge tickets and clinical documentation as appropriate.

6. Develop educational materials and policies/procedures to assist providers with the new regulatory or payer policies.

7. Identifies and assists with implementation of documentation and revenue enhancement opportunities.

8. Collaborates with clinical staff to identify and implement appropriate documentation and coding modifications.

9. Reviews and distributes coding related information to clinical staff, including CPT and ICD-9 code changes, medical necessity policies, coding /billing information regarding new procedures and pharmacy items.

10. Develops educational material and policies and procedures to assist providers with understanding new regulatory or payer policies as they relate to coding changes.

11. Assists in the development of fee schedule updates.

12. Responsible for resolving any coding related errors, edits and denials that are identified by the physician practices or practice billing system.

13. Consults and provides feedback with front line clinical staff, administrators and financial counselors to identify reimbursable indications for treatment.

14. Continuously reviews revenue cycle with management team and supervisor.

15. Participates in education programs to maintain up to date coding skills.

16. Participates with the Compliance Department in random chart audits to ensure appropriate documentation, coding and billing.

17. May prepare presentations for physician and staff practices as needed.

18. May oversee the work of less experienced staff.

*Qualifications

• Associates Degree or HS Diploma/GED plus two years of related medical coding experience
• Four years of experience in medical practice or outpatient coding
• Medical practice business office or patient accounts experience preferred.
• Certification: CPC from accredited institution preferred