Medical Biller

Medical Biller

Full Time

New York, NY

The “TRUE HEALTH” and HEALTHCARE FOR ALL WOMEN OB-GYN. is a for-profit healthcare organization with 7 health centers, providing primary care and preventative medicine in the following locations in Nassau County, Queens, and Brooklyn. As privately qualified health centers, we serve the individuals in our communities, providing enhanced services, expanded hours and reduced prescription pricing, while raising the level of care. We treat patients regardless of income, residency, or immigration status.

TRUE HEALTH offers a stable employment opportunity with a growing company, and competitive base compensation along with health and dental insurance, paid time off, 401-K with company match, paid holidays, employee discounts and much more.

Our Mission

The mission of TRUE HEALTH is to provide access to equitable, comprehensive, optimal healthcare by improving the overall wellness of all individuals in our communities and delivering high quality extensive patient centered care.

Our Vision

Creating healthier communities by transforming the health care system one person at a time.

JOB TITLE: Medical Biller

REPORTS TO: Department Manager/Administrative Manager

The following statements reflect the general duties, responsibilities and competencies considered necessary to perform the essential functions of the job and should not be considered as a detailed description of all the work requirements of this position.

Medical Coding and Billing Specialist

We are looking for an organized and experienced medical coder-biller to join our organization. The medical coder will be responsible for transferring patient and insurance information and initiating payment processes and procedures. The ideal candidate will be well-versed in billing software, medical insurance regulations, and an expert at responding to patient and insurance inquiries. The medical coder will also be responsible for maintaining patient confidentiality, handling personal information, and accurately inputting patient data into the system.

Under general supervision, assigns diagnosis and procedural codes to medical procedures to ensure compliant coding/billing of the facility and office-based services for OB/GYN. Monitors and reviews all medical records to ensure medical coding accuracy, including proper completion and documentation of physician signatures and appropriate coding of all diagnoses and procedures. Thorough understanding of CMS/Medicare regulations and technical knowledge of the International Classification of Disease (ICD-10) and Current Procedural Terminology (CPT-4) classification systems. Provides billing department with accurate, completed coded reports for processing, notifying sites of missing information, and following up accordingly. May provide administrative and data entry support as required. The medical coder will report to the Billing Manager

Medical Biller Duties and Responsibilities:

• Reviews OB/GYN patient medical records and abstracts medical data to accurately capture all diagnoses, procedures, and appropriate modifiers from the medical record documentation using ICD-10-CM, CPT4/HCPCS classification systems.
• Evaluate medical documentation and determine accurate E/M levels for office and hospital records.
• Ensures that CPT and ICD-10 codes are aligned so that there will be no question as to the relationship between diagnosis and treatment, and the claim will be reimbursed.
• Ensures that professional services are captured and coded in compliance with federal regulations and insurance requirements
• Assesses encounter documentation using Center for Medicare and Medicaid Services (CMS) documentation standards. Based on the provider's documentation, identify possible documentation changes that would more accurately account for services provided if implemented. Presents findings to provider and works to resolve the issue.
• Correctly enters coding information into an eClinical Works electronic medical record system.
• Serves as a resource on E/M coding issues to the OB/GYN department.
• Assists with developing processes and procedures structured to optimize reimbursement, limit liability, and enhance data integrity.
• Keeps up to date on billing/coding rules, including the annual update of CPT-4 and ICD-10 codes.
• Maintains CEUS needed for certification.
• Performs all job functions in compliance with applicable federal, state, local and company policies and procedures.
• Maintains productivity standards set forth in Departmental Policies and procedures.
• Ensure patient information is accurate and complete
• Request any missing patient information
• Review referrals and authorizations
• Confirm patient benefits and insurance
• Follow all regulations and guidelines set by Medicare, state programs, and HMO/PPO
• Transfer insurance claims and billing data to billing software
• Create both paper and electronic copies of documentation
• Develop and maintain a tracking system of incoming and late payments
• Monitor and date late payments
• Initiate late payment notices to relevant parties
• Respond to questions and complaints from patients or insurance companies
• Follow-up on late or missed payment notices
• Monitor and resolve financial discrepancies
• Arrange payment plans and timelines for payments
• File and maintain organized documentation of all billing and record
• Follow set billing processes and procedures
• Update and review all accounts to keep records of payments up to date
• Work with personal information and maintain patient confidentiality
• Obtaining referrals and pre-authorizations as required for procedures.
• Checking eligibility and benefits verification for treatments, hospitalizations, and procedures.
• Reviewing patient bills for accuracy and completeness and obtaining any missing information.
• Preparing, reviewing, and transmitting claims using billing software, including electronic and paper claim processing.
• Following up on unpaid claims within standard billing cycle timeframe.
• Checking each insurance payment for accuracy and compliance with contract discount.
• Calling insurance companies regarding any discrepancy in payments if necessary
• Identifying and billing secondary or tertiary insurances.
• Reviewing accounts for insurance of patient follow-up.
• Researching and appealing denied claims.
• Answering all patient or insurance telephone inquiries pertaining to assigned accounts.
• Setting up patient payment plans and work collection accounts.
• Updating billing software with rate changes.

Updating cash spreadsheets and running collection reports

QUALIFICATIONS:

• High school diploma or equivalent; bachelor’s degree in accounting, health care administration, finance, business, or related field preferred
• Two (2) years’ previous experience as a medical biller or in a related healthcare administrative position
• Able to multitask, prioritize, and manage time efficiently
• Self-motivated and self-directed; able to work without supervision
• Excellent verbal and written communication skills
• Proficient computer skills, Microsoft Office Suite (Word, PowerPoint, Outlook, and Excel); working knowledge of billing software a plus
• Strong customer service skills and comfortable answering both patient and insurance company questions
• Able to analyze problems and strategize for better solutions

Basic requirements include:

Education:

• High school graduate or equivalent.1-4-year degree in healthcare or related field preferred.
• Certification in medical coding through AAPC or AHIMA is a must (CCS, CPC, RHIT, RHIA, etc.)
• A high school diploma
• Knowledge of business and accounting processes usually obtained from an associate's degree, with a degree in Business Administration, Accounting, or Health Care Administration preferred.
• A minimum of one to three years of experience in a medical office setting.
• Proficiency in the following areas is preferred:
• Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems.
• Competent use of computer systems, software, and 10 key calculators.
• Familiarity with CPT and ICD-10 Coding.
• Effective communication abilities for phone contacts with insurance payers to resolve issues.
• Customer service skills for interacting with patients regarding medical claims and payments, including communicating with patients and family members of diverse ages and backgrounds.
• Ability to work well in a team environment. Being able to triage priorities, delegate tasks if needed, and handle conflict in a reasonable fashion.
• Problem-solving skills to research and resolve discrepancies, denials, appeals, collections.
• A calm manner and patience working with either patients or insurers during this process.
• Knowledge of accounting and bookkeeping procedures.
• Knowledge of medical terminology likely to be encountered in medical claims.
• Maintaining patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
• Ability to multitask.

Preferred Qualifications

1-3 years CPC experience coding OB/GYN services (office and surgical)

Skills and Experience

• Experienced in coding OB/GYN surgeries.
• Experienced in E/M leveling and coding for both office/hospital professional coding.
• Thorough knowledge of medical terminology, ICD-10-CM, and CPT4 coding is necessary.
• Understanding of both the medical and business side of healthcare operations.
• Highly organized, self-motivated, detail-oriented, and energetic team player.
• Ability to multi-task in a fast-paced environment.
• Excellent verbal and written communication skills. Must be detail oriented.
• Strong computer skills, including MS Office, Internet, and E-mail.
• Excellent problem-solving ability and good interpersonal skills. Epic experience helpful

License/Certification:

Medical Coding Certification (Required)

Experience:

ICD-10: 1 year (Preferred) CPT coding: 1 year (Preferred) GYN, Internal Med, or Surgery Coding (physician billing): 1 year (Required)

Application Question(s):

Do you have a valid CPC or CCS license?

Experience:

• ICD-10: 1 year (Preferred)
• CPT coding: 1 year (Preferred)
• GYN, Internal Med, or Surgery Coding (physician billing): 1 year (Required)

License/Certification:

• Medical Coding Certification (Required)

MORE INFORMATION: This can be a non-exempt or exempt position.

The TRUE HEALTH provides equal employment opportunities to all qualified individuals without regard to race, creed, color, religion, national origin, age, gender, marital status, sexual preference, and orientation, or non-disqualifying physical or mental handicap/disability in each aspect of the human resources function. Applicants as well as employees who are or become disabled must be able to perform the essential job functions either unaided or with reasonable accommodation. The TH shall determine reasonable accommodation on a case-by-case basis in accordance with applicable law.