Billing and Coding Specialist

3 weeks ago

Lake Mary, United States MOORE MEDICAL GROUP INC Full time

***:
Moore Medical Group is seeking a highly motivated individual with an expert knowledge of healthcare billing and coding with an emphasis on auditing and ensuring that all provider coding submissions are reviewed within 48 hours to confirm accuracy and optimization of CPT and ICD-10 codes. The individual will coordinate with central operations and finance to identify areas of improvement and work collaboratively with teams to implement performance improvement plans.

**ESSENTIAL POSITION DUTIES**:
Manage and handle claim submissions and re-submissions, including preparing, updating, and renewing all Participating Provider Agreement forms and documents.
Research denied claims to determine validity, appeal unjustified denials by gathering supportive information from medical records and collaborate with the coding department for necessary coding adjustments.
Demonstrate proficient navigation and use of Nextgen (or other familiar EMR system) for all billing and coding processes.
Analyze payer rejections and develop plan of action to reduce denials and coding issues.
Develop training modules and conduct continuing education to providers to ensure that quality and coding standards are met within the organization.
Strong problem-solving skills to research and resolve discrepancies, denials, appeals and collections.
Oversee and conduct audits of each provider annually and quarterly reporting to ensure coding accuracy.
Collaborate with the billing team to provide real time communication and education to the clinical providers.
Works collaboratively with the Finance team to identify coding risks and areas of improvement.
Review proposed procedure code and related information to ensure that it meets published guidelines.
**Accounts Receivable Management**: Work closely with the billing company to ensure that payments and adjustments are posted in a timely manner.
Prepare and submit necessary medical documentation, including medical records to support billing.
**Liaison with Billing Company**: Act as the primary contact with the billing company on issues such as billing, payment postings, adjustments, and account follow-ups.
Access insurance payer portals to retrieve payment information and post it to Nextgen.
Generate billing and RCM reports to produce regular reporting for the Finance Department/CFO, including aging reports, billing productivity, denial management reports, KPIs and billing reports.

**Professional Experience/Education Requirements**:
Bachelor?s degree in business administration, healthcare administration, or related field.
Must be a Certified Professional Coder (CPC) or Certified Medical Billing Specialist (CMBS).
5+ years of billing and coding including auditing experience in a health-related organization.
Knowledge of ICD-10, CPT codes and medical terminology.
Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems.
Expert knowledge of health insurance providers.
Excellent customer service, interpersonal and organizational skills.
Excellent verbal and written communication skills.
Strong coding, billing, auditing, and technical skills.
Ability to interact with departments throughout the organization.
Detail oriented and able to manage multiple projects concurrently.
Maintain a comprehensive understanding of HIPAA regulations to ensure compliance in all processes.

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