Medical Billing/Coding Specialist - Principle Choice Home Healthcare
Oklahoma City, OK OK
About the Job
PRINCIPLE CHOICE HOME HEALTHCARE
Medical Billing/Coding Specialist
KNOWLEDGE & EXPERIENCE
PHYSICAL ACTIVITY:
The 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 regularly required to use hands to finger, to handle or feel, and talk or hear. The employee frequently is required to stand; walk; reach with hands and arms; and stoop, kneel, crouch, or crawl. The employee is required to sit associated with normal office environment. The employee must occasionally lift and/or move over 100 pounds. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
WORKING CONDITIONS
The work environment characteristics described here are representative of those an associate encounters while performing the essential functions of this job.
Security and privacy training will be provided as part of this role to protect the confidentiality, integrity, and availability of PCS’ associate and customer data.
The above statements are intended to describe the general nature of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.
Principle Choice Home Healthcare is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, parental status, national origin, disability, genetic information, political affiliation, protected veteran status, sexual orientation, gender identity or expression, or any other non-merit-based factors or characteristic protected by federal, state, or local laws.
Medical Billing/Coding Specialist
POSITION PURPOSE
Under the supervision of the Director of Clinical Services the Medical Billing/Coding Specialist utilizes knowledge of insurance regulations, health insurance contracts, medical coding, and bookkeeping to perform a variety of revenue cycle support activities. These include but are not limited to medical coding, insurance verification, ensuring the accuracy of the information housed in the practice management system and EMR, preparing deposits, collecting, posting, and managing account payments, submitting accurate claims, and following up on accounts.
ORGANIZATION
This position reports to the Director of Clinical Services
ESSENTIAL FUNCTIONS includes the following. Other duties may be assigned.
Under the supervision of the Director of Clinical Services the Medical Billing/Coding Specialist utilizes knowledge of insurance regulations, health insurance contracts, medical coding, and bookkeeping to perform a variety of revenue cycle support activities. These include but are not limited to medical coding, insurance verification, ensuring the accuracy of the information housed in the practice management system and EMR, preparing deposits, collecting, posting, and managing account payments, submitting accurate claims, and following up on accounts.
ORGANIZATION
This position reports to the Director of Clinical Services
ESSENTIAL FUNCTIONS includes the following. Other duties may be assigned.
- Extracts relevant information from patient records and acts as liaison with providers and other parties to clarify information
- Gathers required information and documents for the OK Review Choice Demonstration process, submits them, and monitors them in the Eservices platform.
- Examines documents for missing information; corrects information as needed
- Assigns CPT, HCPCS, ICD-10-CM, and DRG codes, as needed.
- Ensure services follow professional standards, state, and federal regulatory requirements.
- Performs patient chart audits and provides coding feedback and education to clinical team as needed.
- Answers questions, advises, and trains providers and staff on medical coding.
- Informs supervisor of equipment and billing software issues and serves as the point person for billing software issues and complications.
- Ensures compliance with medical coding policies and guidelines; understands the application of each code set.
- Maintains current knowledge regarding coding and diagnostic procedures.
- Works towards compliance in all aspects of coding, participates in compliance activities as requested, and conducts/participates in provider coding reviews and education, as requested.
- Assists in the pre-authorization process for contracted insurances.
- Maintains practice management system by entering accurate data, verifying and updating insurance, and claims information, handling carrier correspondence, managing EOBs, and keys payments received into the system.
- Prepare, review, submit, and follow up with clean claims to various companies/individuals.
- Collect, post and manage patient account payments.
- Investigates rejected claims to see why denials were issued and correct claims.
- Facilitate swift payment of invoices due to the organization by sending patient invoices, billing reminders, and making collection calls on outstanding balances as directed by supervisor.
- Completes daily tasks including charge review and claims inspector; creates and maintains custom claim edits and works the client action worklist, and billing A/R worklist.
- Reviews and provides RCM weekly and monthly reports including productivity and financial reports as directed and completes action steps as necessary.
- Follows HIPAA guidelines when accessing and sharing patient information.
- Maintains patient and business confidentiality.
- Provides timely and professional customer service, verify discrepancies by and resolve patient billing issues, answer questions from patients, facility staff, and third-party vendors.
- Supports additional coding, billing, and practice management projects as needed.
- All other duties as assigned.
- Complies with applicable legal requirements, standards, policies, and procedures including, but not limited to the Compliance Program: Code of Conduct, HIPAA, and Documentation Standards.
- Assists in the selection, training, orientation, and competency validation of designated personnel.
KNOWLEDGE & EXPERIENCE
- High School Diploma, GED, or suitable equivalent.
- Coding Certification from AAPC or AHIMA required.
- Minimum of one (1) year work experience as a Medical Coder and Medical Biller.
- Strongly Preferred:
- Minimum five (5) years medical coding and billing work experience working in healthcare; two (2) years medical coding and billing work experience with geriatric or home health populations.
- Knowledge of general accounting principles, revenue cycle processes, medical insurance, and associated regulations.
- High degree of accuracy and attention to detail.
- Ability to manage multiple tasks/projects, and deadlines simultaneously and to identify and resolve exceptions and to interpret data, proficient in data entry.
- Customer service orientation and negotiation skills, including the ability to interface with third party payers.
- Excellent communication skills, both verbal and written.
- Proficient computer skills, including Microsoft Office applications and EMR navigation.
- Active Oklahoma driver’s license.
- Current car insurance and registration.
- Medical knowledge, patience, compassion, kindness, critical thinking skills, knowledge of infection control practices, stamina, and physical endurance, observational skills, knowledge of occupational hazards and safety rules, communication skills, leadership, empathy
PHYSICAL ACTIVITY:
The 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 regularly required to use hands to finger, to handle or feel, and talk or hear. The employee frequently is required to stand; walk; reach with hands and arms; and stoop, kneel, crouch, or crawl. The employee is required to sit associated with normal office environment. The employee must occasionally lift and/or move over 100 pounds. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
WORKING CONDITIONS
The work environment characteristics described here are representative of those an associate encounters while performing the essential functions of this job.
- General office; automobile.
- Requires sitting and standing associated with a normal office environment.
- Performs highly complex and varied tasks requiring independent knowledge and its application to a variety of situations, as well as exercising independent judgement.
- Requires the use of office equipment such as copiers, scanners, computers, telephones, and fax machines.
- May view computer screens for long periods of time.
- Must be able to prioritize activities when faced with competing demands.
- This position will have remote work capabilities and must have the skill set to work independently, exercising sound judgment and maintaining high productivity levels.
- Remote work also requires high levels of electronic and telephonic communication.
Security and privacy training will be provided as part of this role to protect the confidentiality, integrity, and availability of PCS’ associate and customer data.
The above statements are intended to describe the general nature of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.
Principle Choice Home Healthcare is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, parental status, national origin, disability, genetic information, political affiliation, protected veteran status, sexual orientation, gender identity or expression, or any other non-merit-based factors or characteristic protected by federal, state, or local laws.
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