Medical Billing & Coding Specialist
Department: Community Health & Research Center
Location: Dearborn, MI
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Job Title: Medical Billing and Coding Specialist
Job Status: Full-time
COVID-19 VACCINATIONS: ACCESS requires all newly hired employees in certain departments/programs (except those with bona fide medical and religious exemptions) to provide proof of up-to-date vaccination against COVID-19 before beginning employment.
Job Summary: Under close supervision, the Medical Billing and Coding Specialist is responsible for processing health insurance claims for services provided at all clinics. Employee is responsible for submitting claims for reimbursement and coach healthcare providers to achieve optimal reimbursements.
Essential Duties and Responsibilities:
Verify the provider-s determination of services provided and patient diagnoses via office and operative notes
Enter charges in the billing system and/or reviews
Maintain complete knowledge and comply with all relevant insurance, CPT coding and diagnosis guidelines, disseminating info to staff and providers as necessary
Review quarterly provider audits, researching proper coding when necessary and working with coding and compliance as needed
Create relationships with external organizations that allow for streamlining and quick resolution of billing matters for patients
Document conversations with insurance companies and patients
Audit agency reports for procedures with office billing to ensure accuracy of billing to payers
Audit EMR entries to verify correct insurance and demographic information
Attend regularly scheduled meetings
Coordinate and follow through with special projects as assigned
Create a positive, professional, service-oriented work environment for staff, clients and family members by supporting the ACCESS mission and core values statement
Use a special coding system to choose diagnosis and procedure codes
Enter the correct codes into patients- electronic health records
Review claims to make sure coding is accurate
Work with other staff members to ensure accuracy
Enter insurance claims into specialized billing programs
Interact with patients when insurance matters need to be clarified
Follow up with insurers about any late payments
Track payments to make sure reimbursements are received on time
Keep in tune with changes and advancements in the field
May be responsible for credentialing
Operate standard office equipment and use required software applications
Perform other duties and responsibilities as assigned
Knowledge, Skills and Abilities:
Knowledge of:
Billing and managed care department basic services and hours of operation to respond to customer requests accurately
Medical, including surgical, terminology and procedures at the level needed to perform job responsibilities, including understanding of CPT and ICD-9/ICD-10 coding
Rules and regulations regarding insurance claim submissions
Skill in:
Operating standard office equipment and using required software applications for program area and other applications, including Microsoft Office
Critical thinking with the ability to effectively problem solve (e.g. able to determine if a patient issue requires immediate provider attention if there are significant changes to the patient history or other clinical issues that are presented)
Strong customer service skills
Strong multi-tasking skills
Organizational and time management skills to effectively juggle multiple priorities, time constraints and large volumes of work
Ability to:
Operate a standard desktop and Windows-based computer system, including but not limited to, electronic medical records, Microsoft Word, Excel, Outlook, intranet and computer navigation
Use other software as required while performing the essential functions of the job
Communicate effectively with both written and verbal forms, including proper phone etiquette
Work collaboratively in a team-oriented environment; courteous and friendly demeanor
Work effectively with various levels of organizational members and diverse populations including ACCESS staff, patients, family members, insurance carriers, outside customers, vendors and couriers
Cross-train in other areas of practice in order to achieve smooth flow of all operations
Exercise sound judgment and problem-solving skills, specifically as it relates to resolving billing and coding problems
Handle patient and organizational information in a confidential manner
Work under minimal supervision
Educational/Previous Experience Requirements:
Minimum Degree Required:
Associate degree
Bachelor-s degree preferred
~and~
At least 3-5 years previous clinical billing experience or equivalent combination of education, experience and/or training approved by Human Resources.
Licenses/Certifications:
Licenses/Certifications Required at Date of Hire:
Medical Billing and Coding Certificate or Degree in field, Certified Professional Coder (CPC), Nationally Registered Certified Coding Specialist (NRCCS) or Registered Health Information Technician (RHIT)
Working Conditions:
Hours: Normal business hours, some additional hours may be required
Travel Required: Local travel may be required
Working Environment: Climate controlled office
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