Clinical Billing Specialist
2 weeks ago
Overview
The Clinical Billing Specialist is an experienced clinical Medicaid/MCO billing professional that supports the agency’s financial health and overall mission. As part of the Finance department, this role will provide critical review and auditing functions to our billing processes, helping to ensure an effective and efficient method of reimbursement.
Key Role Responsibilities
Perform a variety of billing functions, including charge and payment posting, processing of electronic EDI claims and electronic Explanation of Benefits (EOBs), tracking and follow-up on outstanding or denied claims, and receivable management tracking and reporting
Review and audit critical billing and clinical information, such as EHR charts from multiple departments/specialties, E&M code levels and EHR documentation, diagnoses (represented by the ICD-9-CM coding, ICD-10-CM supporting the services provided, code levels supporting the complexity of the visit, and properly documented and coded CPT procedures
Identify inaccurate coding services and subsequently prepares reports of findings to act as a catalyst for staff education and training on accurate coding practices and compliance issues
Key Agency Responsibilities
In addition to role responsibilities, every staff member has the following responsibilities as a part of their employment:
Models and reinforces the core values of dignity, authenticity, hope, justice, passion and balance
Actively participates in performance improvement and advocacy activities that support the mission
Protects clients’ personal health information by maintaining compliance with HIPAA and other relevant health care-related IT security regulations
Performs other duties on an as-needed basis
Knowledge, Experience, and Skills
Formal Education and Training
Bachelor’s degree or equivalent experience
Certified Professional Coder (CPC) certification preferred
Experience
Two (2) years or more billing experience in a health care setting
Experience in and knowledge of Medicare/Medicaid payer guidelines
Experience with GE Centricity Billing System and working with EMR a plus
Familiarity with insurance verifications and prior authorizations is required
Experience working in a federally qualified health clinic (FQHC) is highly desirable
Comfortable working with homeless and/or low-income individuals and families
Skills
Excellent interpersonal and customer service skills to interact and maintain relationships with a wide range of personalities
Strong organizational skills necessary with strong accountability and drive
Demonstrated proficiency with databases and spreadsheets
Strong communication skills, both written and verbal
Able to cope with interruptions, be flexible, and be a team player
Health Care for the Homeless is an equal-opportunity employer and is committed to racial equity and inclusion. We make a particular effort to recruit and promote Black, Indigenous and People of Color (BIPOC) for open positions. BIPOC, LGBTQIA+ individuals, people with disabilities, and people with other marginalized identities are encouraged to apply.
This is a "flexible" position: At least 50% of position will be remote. General telework location must be within reasonable driving distance of our Baltimore-based offices.
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