Job Summary The Medical Billing Coding Specialist Sr. will help our communities thrive by ensuring our practice remains compliant with documentation and coding during claims billing process. We are a culture that is unabashedly driven by purpose. We are making a difference to our patients and providers while growing at an accelerated rate. Every day, we support the health journey of patients by authentically living our core values: Purpose Driven, Relationships Matter, Serve Others First, and Inspire Creativity. If you love serving others and would like to make a material difference in an industry-transforming organization, then we invite you to apply to this role. We are recognized as one of the Top 100 Places to Work by The Dallas Morning News, and we have been awarded as one of the fastest-growing privately held companies by SMU Cox. Accountabilities - Uses Technical and Functional Experience
- Possesses up to date knowledge of the profession and industry
- Accesses and uses resources when appropriate
- Demonstrates Adaptability
- Handles day to day work challenges confidently
- Is willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change
- Shows resilience in the face of constraints, frustrations, or adversity
- Demonstrates flexibility
- Customer Service
- Demonstrates positive interpersonal relations in dealing with fellow employees, supervisors, physicians, patients as well as outside contacts so that productivity and positive employee/patient relations are maximized.
- Uses Sound Judgment
- Makes timely, cost effective, and sound decisions
Role and Responsibilities: - Perform paper and EMR chart audits for all providers in accordance with third party and CMS requirements.
- Ensure captured charges and billings accurately reflect the medical record according to ICD-10, CPT, HCPCS, and CMS guidelines.
- Coordinates, schedules, and performs the professional services documentation and coding audits of outpatient records for the practice.
- Responsible for maintaining up to date knowledge of coding guidelines as they relate to services rendered such as AMA guidelines, Medicare LCD's, commercial payor billing guidelines, coding manuals.
- Develop and coordinate educational and training programs regarding elements of coding such as appropriate documentation, accurate coding, coding trends found during chart reviews, third party audit findings, and annual coding updates.
- Recommends procedural improvements and training opportunities to management.
- Maintains the confidentiality of medical information contained in each record.
- Assists with other audits such as hospital visits, consultations, and others as assigned.
- Assists with CHG audit and compliance or reimbursement audits such as providing records, audit reports, and standard operating procedure manuals.
- Performs Chart Audits
- Works with healthcare providers to identify areas of coding opportunity to ensure compliance and maximize revenue.
- Develops training material and leads training.
- Demonstrate knowledge of state, federal, and third-party claims processing required.
- Demonstrates knowledge of payer-specific coding requirements.
- Responsible for coordinating team training on coding and payer related updates.
- Creates monthly operations performance reports.
- Reports team performance to Manager and directors on a monthly basis.
- Contributes to interdepartmental projects to meet business needs.
- Develops, interfaces and maintains relationships with providers office leadership, including leading monthly KPI meetings as needed.
- Leads and participates in business unit readouts.
Minimum Qualifications and Requirements: - CPC Certification required.
- High School diploma with at least five (5) years of billing, coding, and medical records experience required and Minimum two (2) years of insurance resolution experience resolving issues with patients and payers.
- Must possess a broad knowledge of managed care and HMO policies and procedures and Medicare benefits. Must possess a strong knowledge of current versions of ICD10, CPT and HCPCS.
- Demonstrate knowledge of medical coding.
- Proficiency with computer systems and Microsoft Office (Word and Excel) required.
Preferred Experience: · Associate degree in finance, Business |
