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EDI-Billing Specialist I

2 months ago

Land O' Lakes, United States Florida Medical Clinic Full time
Job DescriptionJob Description

Our Vision is to be the best choice for healthcare in our community

Job Summary: The EDI Billing & Coding Specialist I is responsible for correcting coding related claim rejections and submitting to insurance for timely payment. Monitors clearing house rejections and researches errors to correct. Communicates common issues and trends to supervisor to prevent reoccurrence. The Coding Specialist must possess a current AAPC CPC (or equivalent) medical coder certification. The coder must be detail-oriented and exhibit a high degree of accuracy and working knowledge of medical terminology, anatomy, and physiology. The coder must have expert skills in the proper use of the ICD-9/ICD-10, CPT, HCPCS coding manuals, as well as, Medicare's National Correct Coding Initiatives (NCCI) edits. Major responsibilities include analyzing medical claims before submission to insurance for accuracy of coding, knowledge and skill to resolve insurance denials, and the ability to accurately complete medical record chart audits while adhering to Medicare's 1995/1997 E/M Documentation Guidelines and individual payer policies.

This Full Time opportunity is within the Central Business Office. The scheduled shift will be Monday-Friday, 8-5.

**REMOTE POSITON*

WHAT DOES FLORIDA MEDICAL CLINIC ORLANDO HEALTH HAVE TO OFFER ITS EMPLOYEES?

We offer a wide choice of compensation and benefit programs that are among the best. From competitive salaries to retirement plans. We make every effort to take care of the people who make our company great.

  • Gives you an employer that you will have pride in working for
  • Provides excellent training programs and opportunities for growth
  • Offers Medical Benefits including:
    • Employer Contributions to HSA high deductible plan
    • Discounts at our medical facilities
    • Cigna Open Access OAPIN & OAP plans
  • Supports Incentive based Wellness Programs
  • Offers company sponsored Life Insurance with buy-up provisions
  • Provides Dental, Vision, Long and Short Term Disability, Accident & Illness policy options
  • Supports Paid Time Off and Holidays
  • Gives generous 401K plan with annual 3% Employer contribution after one year of employment
  • Values and appreciates its employees
  • Boasts a reputation for superior health care and quality service

Work Style/Location:

  • While onsite support may require occasionally, this position will permanently report to a remote/work at home office.
  • Required Equipment for Remote Workforce:
  • Minimum internet hardwired internet speed of 10m x 1m (Satellite, Wireless and or Hot Spot service are prohibited)
  • A dedicated secure home workspace for interview and for work purposes.
  • Acknowledgement and Compliance with all aspects of the Remote Workforce Agreement
  • Employee must provide all necessary computer equipment with the exception of the following which will be provided to them:
  • One Monitor
  • Webcam
  • Connection Cables

Essential Functions of the Position:

  • Essential Functions of the Position:

    • Addresses daily billing tasks in claims control to resolve clearinghouse denial/rejection reports.

    • Researches and corrects claims that are rejected from the claimer's scrubber, clearinghouse or payer.

    • Corrects any patient demographic or insurance information as needed for refiling denied claims

    • Coordinates with the credentialing department to resolve any credentialing issues causing denied claims.

    • Address any clams denied for medical necessity or other coding related rejections/denials with assigned Billing/Coding Specialist I.

Job Qualifications:

  • Knowledge of medical billing and coding, specifically in a multispecialty practice

  • Knowledge of billing guidelines for both government and commercial insurance plans

  • Knowledge of revenue cycle management business objective

  • High School Diploma/GED (or higher).

  • Minimum two years' experience in billing, insurance follow-up, or denials management experience.

  • Strong communication skills (oral and written); must be able to collaborate effectively and work in a team environment

  • Ability to work at a fast pace - meet daily quota

  • Detail oriented with excellent organization skills

  • Ability to multitask and effectively manage numerous competing priorities

  • Ability to work a 40 hour schedule within the operating hours of 7:30 am and 6:00 pm. Must be able to be present at work in the last week of every month plus the first two business days of the following month.

  • Demonstrated ability in using computer and Windows PC applications which include strong keyboard and navigations skills and learning new computer programs.

  • Assumes responsibility for personal development and own actions.

  • Adheres to all policies and procedures, including but not limited to standards for safety, personal conduct, attendance, punctuality and personal appearance.

General:

  • Maintain an organized and clean work area.
  • Phone etiquette.
  • Quantity and quality of work overall.
  • Adheres to FMC policies and procedures

Physical and Mental Demands:

  • Normal physical ability to sit for long periods of time while on the phone.
  • Maintaining a positive and professional attitude.
  • Able to handle stressful situations.
  • Able to meet deadlines.

Keys to Success in this Role:

  • Exhibit expert coding skills
  • Efficiently analyze insurance claims before submission
  • Quickly identify potential compliance issues
  • Ability to proficiently use Payer and coder websites
  • Perform incidental duties as needed

Job Qualifications:

  • High school graduate or GED equivalent
  • Current AAPC, CPC coding certification required.
  • Proficiency in anatomy and medical terminology.
  • Must be able to interact independently with all providers and clinical/business staff to conduct business activities in a courteous and professional manner.
  • Requires proficiency in a Windows based computer environment and skill navigating through a typical Practice management and EHR systems.
  • Requires proficiency in using the Internet to access payer websites for policies and rules.
  • Experience in specialty coding required
  • Must be a Florida Resident
  • 1 year minimum experience required

Physical and Mental Demands:

  • Average physical ability; able to sit for long periods
  • Above average concentration and high level complexity of decision making
  • High level of analytical, critical thinking, and reasoning skills
  • High level verbal and written communication skills
  • Above average ability to manage multiple tasks simultaneously

Occupational Exposure:

  • Low risk exposure to bloodborne pathogens and chemical hazards

#IND123

We are an Equal Opportunity Employer and make employment decisions without regard to race, gender, disability or protected veteran status

Florida Medical Clinic Orlando Health is a drug-free workplace and maintains a policy in which new hires will be required to submit to pre-employment drug testing. This policy is intended to comply with applicable laws regarding drug testing and any privacy rights