Medical Billing and Coding Specialist

The Revenue Cycle Medical Billing and Coding Specialist is responsible for generating and processing medical claims within the Electronic Health Record (EHR) system, implementing payment arrangements, and liaising with various payor entities. This role entails direct interaction with clients, the Colorado Department of Health Care Policy and Financing, and insurance providers to facilitate billing and secure reimbursements for healthcare services delivered. The Revenue Cycle Medical Billing and Coding Specialist is committed to delivering exceptional customer service to both internal and external stakeholders, promptly addressing billing and coding inquiries from staff and clients while safeguarding the confidentiality of sensitive information.

The anticipated hiring range for the role is $25.43/hour - $29.23/hour. The full salary range for this position is $25.43/hour - $35.60/hour.Medicaid and Colorado Health Plan Plus Billing

* Primary point of contact for claim submissions, scrubbing and reconciliation of denials.
* Collects, codes, and transmits patient medical information to collect Medicaid and Child Health Plan Plus (CHP+) reimbursements and other insurance plans or third-party vendors.
* Creates billing policies and procedures that align with Adams County Public Health standards of service delivery.
* Processes patient invoices, statements, collections, billing and write off processes as per all HIPAA guidelines, grant deliverable requirements, TITLE X requirements and any regulatory guidelines or requirements that may apply.
* Audits and resolves discrepant bills, ensures accurate charges and appropriate codes and modifiers are assigned, scrubs claims, and reconciles EOBs, payments and statements sent to patients.
* Monitors accounts receivable and aging and ensures payments are posted to general ledger.



Billing Systems Maintenance

* Serves as liaison with insurance providers to maintain most current fee schedules.
* Provide updates to Nursing Informatics to maintain current CPT, ICD-10 reimbursement in Electronic Medical Record.
* Maintains current fee schedule.
* Ensure appropriate and timely coding of encounters.
* Conducts quarterly chart audits.
* Maintains all provider credentialing related to billing, including maintaining accuracy of codes and rates to ensure accurate quotes at time of service.
* Responsible for optimization of payments and workflows, analyzing the codes and making suggestions on streamlining modifier usage.
* Provides programs with notification of denials and claim status. 
* Creates and maintains process to gain corrections within programs and resubmit claims.
* Reports trends, collection efforts and revenue by payer for budgeting purposes.
* Assists with the following: preparing bank deposits, running reports, completing pre-authorizations and eligibility checks.

Credentialing

* Maintain individual provider and nurse files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.
* Maintain internal provider and nurse grid to ensure all information is accurate and logins are available.
* Update each provider's CAQH database file timely according to the schedule published by CMS.
* Apply for and renew annually all provider licenses; Professional, DEA, Controlled Substance.
* Complete revalidation requests issued by government payers.
* Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid.
* Complete re-credentialing applications for commercial payers.
* Credential new providers and re-credential current providers with hospitals at which they hold staff privileges.
* Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.
* Other duties as assigned.



Emergency Preparedness Duties:

* Employee responds, as required, to support public health emergencies, incidents, and events. Employee participates in all exercises and drills on emergency preparedness, as required. Completes trainings identified as appropriate for this level employee.

Additional Duties:

* Assists in the orientation and training of new employees, students, and interns. Participates in QA/QI projects as needed.
* Conducts ongoing EHR training for new and current staff.

Skills, Abilities, and Competencies:

* Requires a strong understanding of State, Federal and commercial health insurance coverage.
* Requires a strong understanding of medical coding using ICD 11, CPT, HCPCS, and modifiers.
* Requires a strong understanding of AR and Aging Analysis.
* Requires a strong understanding of Revenue Cycle Management.
* Must be able to maintain HIPAA client confidentiality and protect the privacy of client information.
* Strong attention to detail and accuracy.
* Strong communication skills, both verbal and written.
* Strong computer skills, specifically with billing and electronic health record systems.
* Utilize various computer programs.
* Willingness to learn new systems and procedures.
* Self-motivated organizational skills, with the ability to follow a priority structure.
* Exceptional written and verbal communication skills.
* Thrive in a hybrid work environment as part of a team and independently.
* Excellent organizational skills; strong attention to detail and follow-through.
* Project management-type skills; prior experience managing a high-volume workload.



Equipment Used:

* Standard office equipment including, but not limited to, personal computer and associated hardware and software, telephone, copier, calculator, and audio-visual equipment. Demonstrate proficiency in the use of PPE when client facing or as required by health safety policies.

Any equivalent combination of education and work experience that satisfy the requirements of the job will be considered.

Experience:

* Three years medical billing and medical coding experience, including at least one year experience in customer service and experience with electronic health record software and proficiency in using Microsoft office products.
* Experience working with Medicaid, Medicare, and commercial insurances is preferred. 
* Experience in a medical clinic or public health environment is preferred. 

Education & Training: 

* High School diploma or equivalent is required.
* Possession of a Medical Coder OR Medical Billing certification from a credentialing organization such as but not limited to the American Health Information Management Association (AHIMA), American Academy of Professional Coders (AAPC), OR Practice Management Institute (PMI), will substitute for 2 years of medical billing & coding experience. 
* Associate Degree in Health Information or in healthcare related field is preferred
* Registered Health Information Technician (RHIT), OR Certified Coding Specialist (CCS) credential through American Health Information Management Association (AHIMA) is preferred. 
* Medical coding certification. 

Working Conditions and Physical Requirements:

* Spends 90% of the time sitting and 10% of the time either standing or walking.
* Occasionally lifts, carries, pulls, or pushes up to 20 lbs.
* Occasionally uses cart, dolly, or other equipment to carry in excess of 20 lbs.
* Occasionally climbs, stoops, kneels, balances, reaches, crawls and crouches while performing office or work duties.
* Verbal and auditory capacity enabling constant interpersonal communication through automated devices, such as telephones, radios, and similar; and in public meetings and personal interactions.
* Constant use of eye, hand and finger coordination enabling the use of automated office machinery or equipment.
* Visual capacity enabling constant use of computer or other work-related equipment.



Background Check: Must pass a criminal background check.