Job Details

Under limited direction, the Professional Billing Coordinator leads the daily operations of assigned professional billing functions and oversees accounts receivables. The Professional Billing Coordinator provides daily work direction and serves as the department’s technical expert for staff to escalated complex professional billing issues. 

Requirements: 

1. Certified Professional Coder credentials required (RHIT, RHIA, CCS, CCS-P, CPC, or other Professional HIM coding certification).
2. Minimum of 3-5 years’ experience in billing and/or coding required. 
3. Associates degree in accounting or business administration highly preferred.
4. Must possess the technical and professional skills required in professional billing, including insurance verification and benefit determination, medical terminology as it relates to billing and understanding of the reimbursement cycle
5. Must be proficient with computer functions, including ability to use automated systems for third party billing and insurance follow up
6. Ability to work efficiently and effectively under tight deadlines, with interruptions and high work volume.
7. Must possess thorough knowledge of HIPAA requirements regarding all job functions 
8. Ability to work independently with minimal supervision
9. Good oral and written communication skills
10. Ability to manage multiple requests and projects simultaneously

Essential Functions and Responsibilities: 

1. Responsible for Accounts Receivable and Customer Service areas assigned, maintaining standards as set by director.
2. Develops and maintains a body of skills and knowledge on professional billing and reimbursement. Disseminates and/or trains staff on information
3. Maintains current knowledge of compliance regulation, standards and directives regarding governmental/regulatory agencies and/or third party payers.
4. Responsible to maintain quality in billing and follow up for optimum performance in tracking and collecting reimbursement on accounts.
5. Participates in interdepartmental projects including provider onboarding, practice and provider education, coding review and other special projects. Provides training to department staff as well as site staff and providers.
6. Manages CPT/ICD-10 code usage to ensure accurate, effective communication with providers regarding coding trends and accurate coding. Reviews appropriate coding and recommends/makes changes as appropriate.
7. Collaborates with departments to ensure services performed are charged and posted in a timely and compliant manner. 
8. Reviews claims daily, for accuracy and necessary attachments, utilizing electronic billing software.
9. Identifies underpayments specific to contract language and working with contracting department.
10. Maintains daily work queues according to payer requirements, including, insurance coverage, claim errors, payer denials, insurance follow up and collections.
11. Provides periodic monitoring and analysis of productivity metrics to support internal controls and monitor employee performance.
12. Provides staff training, coaching, support, issue identification, assessment, resolution and keeping the director apprised of the progress. Responsible for input in recruitment and corrective action decisions as well as performance evaluations.
13. Responsible for oversight of daily operations within the assigned department. Meets quality and productivity standards established by management. May need to work additional hours (evenings/weekends) to achieve team goals. Provides coverage and support for other teams.