[Hiring] Medical Coding and Billing Specialist @OneOncology

Role Description

The Medical Coding and Billing Specialist is responsible for writing and maintaining coding and billing rules in the practice management system. The position is also responsible for reviewing and importing daily Urologic and Surgical charges and daily claim filing. Excellent verbal and written communication skills required. The coding and billing works under the direct supervision of their respective team manager.

Responsibilities

• Review and verify patient insurance coverage and eligibility for Urologic and Surgical treatments.
• Verify all applicable charges for Urologic and Surgical services are entered timely and accurately into the practice management system for reimbursement.
• Generate and submit accurate and timely claims for Urologic and Surgical services to insurance payers.
• Monitor and track claims through the billing process to ensure timely payment and identification of payer roadblocks.
• Assist with investigation and resolution of any claim rejections, denials, or appeals related to Urologic and Surgical treatments.
• Review and interpret insurance policies and regulations related to Urologic and Surgical treatments to ensure compliance with billing requirements.
• Work collaboratively with the Urologic and Surgical center's medical and pre-authorization teams to ensure accurate and complete billing for their Urologic and Surgical treatments.
• Maintain accurate and up-to-date records of billing activities in patient files and computer systems.
• Ability to review and interpret Urologic and Surgical medical records for accuracy as it relates to coding and billing. Educate clinical team on appropriate documentation requirements.
• Assist team members with responses to patient and insurance company inquiries about billing for Urologic and Surgical treatments in a timely and professional manner.
• Stay current with industry trends, changes to insurance policies, and other developments that may impact the billing process for Urologic and Surgical treatments.
• Reviews charges in “Approve Failed” status daily for accuracy and corrective action.
• Contacts the appropriate department to follow up on pending issues for insurance and referrals.
• Drafts appeal letters based on payer policy to support AR functions.
• Reviews charges on “Hold” status daily for accuracy and corrective action.
• Creates new Candid rules/edits as needed to reduce claim denials and/or manual review.
• Maintains Candid rules to ensure data is current.
• Answers Urologic and Surgical coding inquiries from the AR team.
• Keeps informed regarding current coding regulations, auditing, professional standards and company/department policies and procedures as it applies to the fields of Urology and Surgery and effectively applies this knowledge.
• Communicates effectively with practice leadership regarding coding issues to help ensure coding compliance and minimize denials.
• Demonstrates outstanding work ethic and works cooperatively with all team members and management.
• Additional responsibilities may be assigned to help drive our mission of improving the lives of everyone living with cancer.

Qualifications

• Bachelor's degree preferred.
• Minimum two years’ experience in charge entry/billing required.
• 1+ year(s) of Prior Authorization experience.
• Extensive knowledge of CPT, HCPCS, and ICD-9 coding in addition to insurance billing guidelines required.
• Proficiency in Microsoft EXCEL spreadsheets and strong computer background.
• Medical insurance background required.
• Expertise in insurance policies and regulations related to medical billing, including Medicare and Medicaid.

Requirements

• Must be willing and able to lift up to 25 pounds.
• Must be willing and able to travel to satellite clinics when necessary.

Essential Competencies

• Attendance is an essential job function.
• Ability to work effectively with all levels of management and other colleagues.
• Ability to demonstrate initiative and mature judgment.
• Ability to demonstrate high degree of professionalism and adaptability.
• Ability to demonstrate proficiency in the use of end-user computer applications (MS Word, Excel, Outlook), database and patient scheduling and other medical information systems.
• Ability to demonstrate strong customer service delivery skills.
• Ability to utilize websites, portal and electronic options when available to increase efficiency.
• Ability to follow oral and written instructions.
• Ability to recognize and solve problems using creative thinking skills, hands on problem solving skills and the ability to analyze and respond to data.
• Skilled at effective verbal and written communications, including active listening skills and skill in presenting findings and recommendations.
• Skilled at multi-tasking, organizational skills and superb attention to detail.
• Working knowledge of Hospice and other payer requirements.
• Knowledge of clinic office procedures, medical practice and medical terminology.