Effective: January 2022
POSITION: Billing Specialist /Certified Professional Coder CPC
SUMMARY OF DUTIES: Responsible for entering charges for the professional, and ASC claims. This includes electronic and paper claim submission. As a certified coder, reviews claim prior to submission for coding accuracy and provides feedback/education as needed in conjunction with the Billing Manager. Certified Coder CPC will be responsible for assigned insurance aging accounts with particular focus on the facility claims and may also provide phone coverage through billing call center, answering billing questions by phone, assisting patients in making payment arrangements, problem solving. THIS IS NOT A REMOTE POSITION
SUPERVISION RECEIVED: Reports to the Billing Manager; may receive direction from Administrator and/or Physicians.
ESSENTIAL FUNCTIONS:
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Verifies correct insurance information on claim.
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Enters charges for patient clinic visits and ASC procedures into the practice management system and appends modifiers when appropriate.
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Verifies accuracy of coding from physician notes.
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Report missing or incomplete documentation.
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Understands and abides by billing compliance regulations.
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Understands Medicare/payer groups rules and regulations.
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Daily electronic claim submission and reviewing claim errors in clearinghouse.
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Works assigned insurance aging reports, resolving billing and processing problems for assigned accounts within assigned insurance groups.
- Working knowledge of all published payer medical policies relevant to practice specialty, including Medicare LCD’s and NCD’s.
- Performs coding and error resolution requiring independent judgment and knowledge of ICD-10 and CPT coding.
- Anticipate and solve problems from all above areas of responsibility, with the primary consideration being the efficiency of the physicians and the office.
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Works assigned aging accounts with particular focus on facility claims aging.
- Provides coverage for billing department call center assisting patients with questions regarding their bills.
EDUCATION: High school graduate and Certified Professional Coder credentials required from American Academy of Professional Coders or RHIT through AHIMA. College degree preferred.
EXPERIENCE: At least two years healthcare experience in billing, coding, and processing of insurance claims and claims resolution. Surgical and pain management billing is a plus
KNOWLEDGE:
- Understanding of medical terminology, anatomy, and physiology.
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ICD-10 and CPT coding proficient.
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Knowledge of third-party and insurance procedures, regulations and billing requirements, and government reimbursement programs.
SKILLS:
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Skill in establishing and maintaining effective working relationships with other employees, patients and their families, organizations, and the public.
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Basic computer skills and knowledge of practice management software.
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Detail oriented with a high level of accuracy.
ABILITIES:
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Ability to read, understand and follow oral and written instruction.
2 Ability to sort and file materials correctly by alphabetic or numeric systems.
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Ability to communicate clearly.
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Ability to prioritize and handle many tasks/projects simultaneously.
Ability to be proactive - - anticipate problems before they occur.
ENVIRONMENTAL/WORKING CONDITIONS: Work is performed in a busy office environment and requires desk work. Frequent contact with employees, patients, and outside agencies. Public contact may involve dealing with angry or upset people.
PHYSICAL DEMANDS: Sitting required for extended periods of time. Manual dexterity for using a calculator and computer keyboard. Some bending and stooping required.
This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.
