Billing & Certified Coding Specialist I

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Identifies, reviews, and interprets third party payments, adjustments and coding denials for all professional services. Reviews provider documentation in order to determine appropriate coding and initiate corrected claims and appeals. Duties include hands on coding, documentation review and other coding needs for ICD-9, ICD-10. Works directly with the Billing Supervisor and Coding Manager to resolve complex issues and denials through independent research and assigned projects. (remote) Job Description: Essential Duties & Responsibilities including but not limited to: Coding Responsibilities: 1. Provides review and/or coding of any coding related denied professional services for appropriate use of CPT, ICD-9, ICD-10, HCPCS, Modifier usage/linkage. 2. Periodic review of codes, at least annually or as introduced or required. 3. Reviews and analyzes rejected claims and patient inquiries of professional services, and recommends appropriate coding corrections via paper or electronic submission to the Follow up Team. 4. Reports coding trends and issues to the coding supervisor for education within the coding department and/or physician education. 5. Confers regularly with the Coding Department through regular departmental staff meetings, on-on-one meetings to review and discuss coding denials and education. 6. Maintains certification requirements for coding. Follow Up Responsibilities: 1. Monitors days in A/R and ensures that they are maintained at the levels expected by management. Analyzes work queues and other system reports and identifies denial/non-payment trends and reports them to the Billing Supervisor. 2. Responds to incoming insurance/office calls with professionalism and helps to resolve callers’ issues, retrieving critical information that impacts the resolution of current or potential future claims. 3. Establishes relationships and maintains open communication with third party payor representatives in order to resolve claims issues. 4. Reviews claim forms for the accuracy of procedures, diagnoses, demographic and insurance information, as well as all other fields on the CMS 1500. 5. Reviews and corrects all claims/charge denials and edits that are communicated via Epic, Explanation of Benefits (EOB), direct correspondence from the insurance carrier or others and uses information learned to educate PFS and office staff to reduce future denials and edits of the same nature. Initiates claim rebilling or corrections and obtains and submits information necessary to ensure account resolution/payments. 6. Identifies invalid account information (i.e.: coverage, demographics, etc.) and resolves issues. 7. Evaluates delinquent third party accounts and processes based on established protocols for review, payment plan or write-off. 8. Reviews/updates all accounts for write-offs and refunds. 9. Keeps informed of all federal, state, and managed care contract regulations, maintains working knowledge of billing mechanics in order to properly ascertain patients’ portion due. 10. Completes all assignments per the turnaround standards. Reports unfinished assignments to the Billing Supervisor. 11. Handles incoming department mail as assigned. 12. Attends meetings and serves on committees as requested. 13. Maintains appropriate audit results or achieves exemplary audit results. Meet productivity standards or consistently exceeds productivity standards. 14. Provides and promotes ideas geared toward process improvements within the Central Billing Office. 15. Assists the Billing Supervisor with the resolution of complex claims issues, denials and appeals. 16. Completes projects and research as assigned. 17. Provides feedback and participates as the coding representative for the Patient Financial Services Department on the Revenue Cycle teams. Secondary Functions: 1. Enhances profess