JOB SUMMARY:
The Billing & Coding Coordinator oversees clinics’ billing and coding operations and management and is responsible for general day-to-day billing and financial administration of operational duties and administration for team Billing & Coding and finances processes.Will setup, maintain and oversee all web-based applications regarding billing and coding EMR, and clearing House. Supervisors for Billing & Coding Documentation Specialist, and overseeing their daily duties, training and billing, coding and coordinating, financial coordinator, documentation coordination directly reporting to the Accounts Receivables and in regard to all financial and accounting activities, and any additional duties. The Coordinator is responsible for coordinating the resolution of complex coding denials, and questions related to claims coding for patients. The Coordinator will perform auditing of offshore coding for quality assurance and education. Collaboration with assigned client/RCM teams, providing education on coding denial trends and/or opportunities for coding improvement and documentation requirements. The Coordinator will also create presentations, develop learning material, and provide feedback to internal and external customers on denials and coding improvements.
QUALIFICATIONS REQUIRED AND EXPERIENCE:
Master’s Degree preferred or BA or BS in Finance, Accounting or Finance, experience with Accounting and/or Finance and Healthcare Administration experience, a minimum of 2 years of recent or previous Healthcare Administrative experience and one of the following Current Coding Certificate is required (CPC) Certified Professional Coder (CPB™) , ( CPC-H )Certified Professional Coder-Hospital Outpatient, Certified Professional Biller, (CPMA®) Certified Professional Medical Auditor and (CDEO®) Certified Documentation Expert Outpatient.
POSITION RESPONSIBILITIES AND TASKS:
- Complies with internal controls and policies and procedures
- Prepare invoices for patients and insurance billing, submit and process insurance claims
- Coordinating Billing for all programs (Private Pay, Third Party Billing, MassHealth, State
- Prepare reports Account payable and receivable for Patient Account
- Processes Electronic Claims via Coding Specialist, Data Quality Analyst
- Conducting prior authorization reviews obtains extensions to continue services
- Enters all review results into appropriate data systems and excel sheets as Claims Reviewer
- Claims status and resubmitted claims, Medical Collector to collect payments
- Assisting in appeal hearings related to prior authorization denials
- Documenting all review findings in the designated review database;
- Creating correspondences and communications required by the contract, including denials
- Creating reports reflecting the start and end date of services and keeping track of billing units used
- Coordinate accounts payable and receivable for payments
- Maintaining all files and clinic billing documents
- Data entry and organizing computer-based information
- Maintain confidentiality in all aspects of client, staff, and agency information.
- Maintain electronic and hard copy filing system
- Analyze patient accounts, identifies billing issues and determines solutions with patients and insurance companies
- Organize all internal and external funding billable accounts and identify all collection issues and assist in appropriate resolution.
- Monitor all claim activities and manage vendor invoicing and prepare appropriate financial reports.
- Experience and knowledge of healthcare and medical terminology, including but not limited to: CPT, ICD9 /ICD10 codes and use of modifiers
- Mantians Revenue Cycle knowledge in the following areas including PFS, Customer Service, Cash Posting, Financial Assistance, Patient Access, HIM/Coding and/or 3rd party Reimbursement.
- Monitor all authorizations activities and manage vendor authorizations billing units and prepare appropriate financial reports
- Assisting in appeal hearings related to prior authorization denials
- Prepare invoices for patients and insurance billing, submit and process insurance claims
- Coordinating Billing for all programs (Private Pay, Third Party Billing, MassHealth, State
- Prepare reports Account receivable for Patient Account
- Processes Electronic Claims via Coding Specialist, Data Quality Analyst
- Conducting prior authorization reviews obtains extensions to continue services
- Enters all review results appropriate data systems and excel sheet as Claims Reviewer
- Claims status and resubmitted claims, Medical Collector to collect payments
- Summary Reporting to the Director Revenue Cycle and Billing & Coding Manager, the Coding Coordinator provides coding and revenue cycle support to the Department of Emergency Medicine
- The Coding Coordinator is responsible for the review and resolution of all coding related pre-billing edits and/or rejections to ensure prompt and accurate reimbursement
- This Coordinator initiates medical record reviews and recommends proper action
- This Coordinator communicates with direct care staff and medical staff and billing staff regarding missing or unclear documentation
- This Coordinator will analyze and report trends with team members to report to Managers
- Responsibilities Reviews and resolves all assigned tasks and encounters associated with potential coding discrepancies as it relates to pre-billing system edits and/or claims with outstanding balances
- Reviews and resolves any pre & post billing coding edits (TES) and resubmits claims for adjudication
- Ensures all services documented in patient charts are coded with appropriate diagnoses, CPT & HCPCS procedure codes Aims to reduce accounts receivable by reviewing claims rejected for coding; investigates assigned accounts to determine what additional steps must be taken for claims to be resolved
- Conducts one-on-one or small group education for direct care staff and medical staff regarding the results of their periodic audits while maintaining an exceptionally high level of professionalism Assists providers in developing effective Letters of Medical Necessity (LMN) and/or templates for appealing denials associated to complex procedures based on payer requirements and medical documentation
- Maintains a thorough working knowledge of all aspects of billing and collections including billing rules and regulations, collection practices, electronic billing processes, CMS 1500 Form requirements, diagnosis and CPT/HCPCS coding, and applicable county, state, and federal requirements
- Researches and response to insurance coding requests; assist with claim issues, including preparing coding appeals
- Proactively elevates coding problems to the providers and maintains tracking reports when issues and trends have been identified
Maintenance & Quality Improvement:
- Maintain daily account payable and receivable
- Data entry in QuickBooks
- Internal Audits of Staffing Documentation for billing
- Creating financial reports
- Submitting billing claims and resubmitting claims research for payment
Accounting:
- Prepare expense reports,
- Bookkeeping billing on Account receivable and payable
- Financial Reporting (closing the books)
- Account Reconciliation, including cutting checks for payment of agencies services used
KEY SKILLS & BEHAVIOR:
- Strong analytical skills and interpersonal skills willing to work directly with patients and clients
- Ability to communicate effectively within a variety of situations and diverse populations
- Ability to work independently and as part of a team
- Excellent time management skills
- High attention to detail