Billing Specialist

PURPOSE:

Reporting to the Billing Team Supervisor, the Billing Specialist is responsible for accurate and timely claim submissions, follow ups and denial management. The Billing Specialist is well-versed in CPT, HCPCS and ICD-10 coding, applying this knowledge to ensure the highest level of reimbursement is achieved following payer guidelines and standards.

ACCOUNTABILITIES AND JOB ACTIVITIES:

• Review encountered superbills to ensure the provider captured all CPT and ICD-10 codes accurately
• Review clinical documentation to confirm accuracy
• Submit reviewed claims in a timely manner as outlined by the Billing Team Supervisor
• Analyze errors, identify trends, and provide feedback to the Billing Team Supervisor and providers
• Edit claims for modifier, coding, and bundling errors
• Review denied claims and initiates appeals when applicable
• Ensure all coding and documentation meets all payer guidelines and standards
• Provide coding and documentation feedback to providers and staff
• Investigate overpayments and payer refund requests, initiate take backs and process refunds on a regular basis in accordance with payer policies
• Manage work queues timely and effectively
• Assist with patient and payer inquiries
• Ability to share knowledge with team members and department leaders throughout the organization
• Receive patient payments via telephone
• Other duties as assigned

Develop and maintain personal and professional skills

• Attend all mandatory staff meetings per year unless excused as evidenced by documentation
• Attend mandatory in-services and a minimum of two pertinent in-services per year as documented
• Actively participate in performance improvement activities as observed or documented
• Establish realistic professional goals as evidenced by the annual performance evaluation
• Actively keep abreast of departmental and organizational activities
• Demonstrate flexibility in response to unexpected change in workload or situations as observed
• Serve on committees and/or participates in changes of policy and procedures that affect the revenue cycle
• Assist in the orientation of new personnel as directed
• Support the mission and goals of the company as observed
• Address all emails within 24 hours as documented
• Perform other duties as required

Demonstrate safe and cost-effective practice

• Consistently adhere to OSHA bloodborne pathogen guidelines; apply universal precautions per company standards as observed
• Consistently utilize proper body mechanics as observed
• Accurately complete incident reports within the shift of occurrence and immediately communicates critical incidents to the appropriate person per the organizational chart
• Consistently allocate resources to reduce waste and minimize costs as observed
• Consistently complete assigned duties within stated shifts in a timely manner as observed and documented

BEHAVIORAL EXPECTATIONS

Strive for excellence

• Set challenging goals
• Produce quality work in a timely fashion
• Maintain current knowledge and skill
• Participate in quality and process improvement efforts
• Keep the work area clean, safe and secure

Act Flexibly

• Adapt to change
• See the value of different opinions and new ideas
• Change plans and objectives given new direction or priorities
• Handle stressful situations effectively

Meet Customer Needs

• Meet internal and external customers’ needs
• Find new ways of satisfying customers
• Participate in service improvements efforts
• Listen and respond to customers
• Treat customers with compassion and respect

Work as a Team

• Work as a team player
• Pitch in to help those in need
• Communicate with others appropriately
• Listen and respond to others
• Handle conflict situations effectively
• Foster trust and respect within the team
• Participate in committees and task forces

Foster Diversity in the Workforce

• Treat all associates and customers with respect, integrity and dignity regardless of background, race, age, gender, gender identity, sexual orientation, religion or disability
• Treat all associates and customers fairly

Be Self-directed

• Take initiative and responsibility for actions
• Identify own learning needs and create/implement Learning Plans
• Perform duties according to policies and procedures
• Demonstrate ethical behaviors
• Maintain confidentiality of information
• Maintain licenses and certifications as appropriate
• Fulfill operating unit/clinical competencies
• Use equipment/resources responsibly

You must refer to upper management for approval or final disposition on the following

• Change in procedure
• Difficult patient situations
• Any situation you are unsure of

JOB SCOPE AND WORK ENVIRONMENT:

This position is subject to:

• Confidential information
• Extended time sitting at a desk, utilizing a keyboard and multiple monitors
• High stress environment due to turnaround requirements
• Daily hours are subject to change on a daily basis due to schedule

Patient Privacy HIPAA

• Protection of patient privacy
• Patient records and EMR are for treatment use only

The statements in this job description are intended to describe the essential nature and level of work performed by employees assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of personnel so classified.