Billing and Coding Specialist

Working title: Billing and Coding Specialist        

Classification title: Bookkeeping, Accounting and Auditing Clerks (43-3031)

Division: Administration                                                               

Program: Fiscal Services

Reports to:   Medical Billing Manager 

FLSA status: Non-Exempt: Full-time

Schedule: Monday-Friday; 8am-5pm

Wage Range: $19.36 to $24.14 hourly; depending on number of years of transferrable experience and internal equity

RiverStone Health:

Serving the Yellowstone County community and south-central Montana for nearly 50 years, RiverStone Health is an essential provider of personal and public health services. Health, Education, Leadership and Protection – HELP is what we do. 

From medical, dental and behavioral healthcare; home care and hospice; public health services like immunizations, WIC, health promotion and restaurant inspections; and educating the next generation of health professionals, our expertise spans all ages and stages of life.  Underlying principles of access, affordability, compassion and quality in all interactions, RiverStone Health improves life, health and safety for all of the communities we serve.

Job Summary:

Performs a variety of tasks in coding and billing. This may include claims review and submissions as well as technical accounts payable and receivable functions specializing in billing and collections for all RiverStone Health Clinic Facilities.

Essential Functions/Major Duties and Responsibilities: 

A.   Accounting Tech-Medical/Dental Billing and Coding Specialist                          90%

• Obtains billing information from medical and dental care providers.

• Analyzes and prepares Medicaid, Medicare, and insurance claims for billing. Verifies claim accuracy and completion.

• Adjusts invoices for patient discounts and amounts based on insurance provider and government program allowances. Prepare and distribute billing invoices at least monthly.

• Performs preliminary “audits” of patient electronic charts to ensure billing information is included and coded properly.

• Establishes and maintains patient financial files. Post charges and payments to patient accounts.

• Posts patient and insurance payments against accounts receivable balances into the electronic health record, eCW. Reconciles differences between actual and expected payments.

• Respond to questions pertaining to patient invoices, sliding fee discounts and payment plans; discusses payment options and sets up payment plans when

• Develop monthly accounts receivable days tracking systems and closely monitor aging accounts. Include discounts applied and write-off percentages tracking.

• Enters miscellaneous payments made to RiverStone Health into the deposit spreadsheet or other deposit-tracking system.

• Post pharmacy Medicaid payments in pharmacy software.

• Investigates anomalies, errors, and discrepancies in accounts.

• Processes payment denials and errors and takes appropriate follow-up measures.

• Provides guidance that assists new employees with work tasks to new employees in the same or similar class of positions.

• Informs the immediate supervisor and designated others about work progress, present and potential work problems, and suggestions to address problems.Billing

• Responds to citizens’ questions and comments with courtesy and in a timely manner.

• Communicates and coordinates regularly with others to maximize the effectiveness and efficiency of interagency operations and activities.

• Attends meetings, conferences, workshops, and training sessions and reviews publications and audio-visual materials to become and remain current on principles, practices, and new developments in assigned work areas.

• Communicates with patients, families, or payors

• Performs other functions as assigned by specific programs.

Non-Essential Functions/Other duties as assigned                                        ≥10%

• Perform other duties as assigned in support of RiverStone Health’s mission and goals.

Education and Experience: 

Minimum Qualifications

• High school diploma or GED; plus

• Experience and/or training directly related to ICD-10 coding applications

• Any combination of experience and training which provide the equivalent scope of knowledge, skills, and abilities necessary to perform the work.

Preferred Qualifications

• ICD-10 Coding certification

Required Certificates, Licenses, Registrations:

• Must become Certified Professional Coder (CPC) credentialed within 12 months of hire date if not already credentialed.

Knowledge, Skills, and Abilities: 

• Computer literacy including MS Excel and Office Suite™ and knowledge of office procedures and equipment

• Performs data entry relevant to job duties.

• High degree of detail-orientation

• Knowledge and understanding of protected sensitive patient health information (HIPAA) and confidentiality

• Ability to meet deadlines

• Work collaboratively to contribute to a positive work experience

• Communicate calmly, focused on the issue, and with empathy

• Able to perform each essential duty satisfactorily.

Customer Service Excellence: 

• Doing things right the first time

• Making people feel welcome

• Showing respect for each customer

• Anticipating customer needs and concerns

• Keeping customers informed

• Helping and going the extra mile

• Responding quickly

• Protecting privacy and confidentiality

• Demonstrating proper telephone etiquette

• Taking responsibility for handling complaints

• Being professional

• Taking ownership of your attitude toward Service Excellence.

Supervision: 

• None

Physical Demands and Working Conditions:

• Work is mainly performed on a computer up to 8 hours per day.

• Use of repetitive motion

• Standing, bending, sitting, lifting required

• Work is performed in an office environment and requires the ability to operate standard office equipment and keyboards. Must have the ability to lift and carry a laptop and other small items, to walk short distances.

• Ability to see details near and far, recognize color differences, and focus on fine details like small print and/or instruments required. 

• Create and maintain a safe/secure working environment by adhering to safety, security, and health requirements. Integrates injury, illness, and loss prevention into job activities by attending any necessary training and implementing best practices.

Freedom to Act & Decision Making: 

• Limited discretion: actions subject to regulations, contract requirements, generally accepted accounting principles and supervision.

Communications & Networking: 

• Respond effectively during tense / emotional conversations with patients or their family members and payors.

• Responsible for maintaining confidentiality and sharing only information relevant to inquiries

• Professional communication style with payors, insurers, and patients

Budget & Resource Management: 

None