Coding and Billing Specialist

A career at Community Health Centers offers a unique opportunity to join a team that makes a real impact in our community every day, by improving individuals' health while enhancing their quality of life. 

Top Reasons to Work at Community Health Centers

  • A great benefits package that includes healthcare coverage, retirement plans, vacation, sick leave, and more.
  • Competitive compensation with advancement opportunities and tuition / training reimbursement.
  • Awarded “Best and Brightest Companies to Work for in the Nation” in 2018.
  • Awarded “Top 100 Workplaces for Growing Families” by Orlando Sentinel.
  • Modernized and attractive health centers, that patients love.

Job Summary:

The Coding and Billing Specialist reviews, analyzes and assures the final diagnoses and procedures as stated by the practicing providers are valid and complete.  Accurately codes office and hospital procedures for providers to ensure proper reimbursement.  Provides education to the providers to ensure proper completion of Electronic Health Records and proper assignment of ICD-10, HCPCS and CPT codes. 

Primary Responsibilities and Specific Duties:

  • Reviews, analyzes and assures the final diagnoses and procedures as stated by the practicing providers are valid and complete. 
  • Reviews medical records to ensure proper submission of services prior to billing on pre-determined selected charges.
  • Reviews medical records to ensure proper coding completed and to ensure compliance with federal and state regulatory agencies.
  • Ensures correct ICD-10 diagnosis codes on all diagnoses provided.
  • Ensures correct HCPCS codes are on all procedures and services performed, along with the CPT codes.
  • Accurately follows coding guidelines and legal requirements to ensure compliance with federal and state regulatory agencies.
  • Attends seminars and in-services as required to remain current on coding issues and obtain necessary CEUs to maintain CPC certification
  • Maintains compliance standards in accordance with the Compliance policies and the Code of Conduct and reports compliance problems appropriately.
  • Quantitative analysis – Performs a comprehensive review of the record to assure the presence of all component parts such as: patient and record identification, signatures and dates were required, and all other necessary data in the presences of all reports which appear to indicated by the nature of the treatment rendered.
  • Qualitative analysis – Evaluates the record for documentation consistency and adequacy.  Ensures that the final diagnosis accurately reflects the care and treatment rendered.  Reviews the records for compliance with established reimbursement and special screening criteria.
  • Analyzes provider documentation to assure the appropriate Evaluation & Management (E&M) levels are assigned using the correct CPT code.
  • Reviews claims for accuracy in accordance with Medicare, Medicaid and Managed Care policies.
  • Transfers balances to patient's responsibility on non-covered items, benefits denied or charges applied to the deductible.
  • Researches and ensures corrections are made on denied claims due to missing or incorrect information.
  • Performs insurance collection (follow-up) function utilizing the collection system management and aging reports.  As a part of this function generates and reviews aging reports to submit to insurance carriers when appropriate and in accordance with established guidelines.
  • Runs paper claims when necessary and submits claims to appropriate fiscal intermediary.
  • Prepares all refund paper work for accounts payable and enters adjustments into the eClinical Works (eCW) System.
  • Communicates to Patient Accounts Receivable Coordinator any coding and/or billing challenges.
  • Answers questions related to insurance and patient billing for all internal/external customers.
  • Ensures accuracy of payments received from third party payers per contracts and current reimbursement rates.
  • Posts contractual adjustments as required to Medicare, Medicaid, HMO, PPO and other accounts per contracts and current reimbursement rates.
  • Collects and posts payments, and completes appropriate forms/reports and submits daily to Patient Accounts Receivable Coordinator and Bookkeeper.
  • Performs all other duties as assigned.

Qualifications:

Education:   

  • High School Diploma or equivalent is required.

Experience:   

  • Three years of medical billing and collection background and experience in a physician practice setting is required. 
  • Must be experienced in working with eClinical Works or other similar medical software products. 
  • Must have basic knowledge of medical terminology.
  • Must have good communication and customer service skills.

Certification/Licensure: 

  • Certified Professional Coder (CPC) required.

Special Skills: 

  • Knowledge and experience on CPT-4 and ICD-9 and 10 coding and the ability to use coding books. 
  • Must understand the billing procedures for Medicare/Medicaid, Workers Compensation, HMOs, PPOs and other managed care and commercial insurance plans. 
  • Must have knowledge of state credit laws and regulations and generally accepted collection practices. 
  • Ability to read, understand, and follow oral and written instructions.
  • Maintain patient confidentiality.
  • Excellent communication and customer service skills.

Other requirements:

  • Able to work flexible hours as needed.