Medical Billing Specialist

3 weeks ago

Edmond, Oklahoma, United States Principle Choice Home Healthcare Full time
Job Title: Medical Billing/Coding Specialist

At Principle Choice Home Healthcare, we are seeking a highly skilled Medical Billing/Coding Specialist to join our team. As a key member of our revenue cycle team, you will be responsible for ensuring the accuracy and efficiency of our medical billing and coding processes.

Key Responsibilities:
  • Extract relevant information from patient records and act as liaison with providers and other parties to clarify information
  • Gather required information and documents for the OK Review Choice Demonstration process, submit them, and monitor them in the Eservices platform
  • Examine documents for missing information, correct information as needed, and assign CPT, HCPCS, ICD-10-CM, and DRG codes as required
  • Ensure services follow professional standards, state, and federal regulatory requirements
  • Perform patient chart audits and provide coding feedback and education to clinical team as needed
  • Answer questions, advise, and train providers and staff on medical coding
  • Inform supervisor of equipment and billing software issues and serve as the point person for billing software issues and complications
  • Ensure compliance with medical coding policies and guidelines and maintain current knowledge regarding coding and diagnostic procedures
  • Work towards compliance in all aspects of coding, participate in compliance activities as requested, and conduct/participate in provider coding reviews and education as requested
  • Assist in the pre-authorization process for contracted insurances
  • Maintain practice management system by entering accurate data, verifying and updating insurance, and claims information, handling carrier correspondence, managing EOBs, and keying payments received into the system
  • Prepare, review, submit, and follow up with clean claims to various companies/individuals
  • Collect, post, and manage patient account payments
  • Investigate rejected claims to see why denials were issued and correct claims
  • Facilitate swift payment of invoices due to the organization by sending patient invoices, billing reminders, and making collection calls on outstanding balances as directed by supervisor
  • Complete daily tasks including charge review and claims inspector, create and maintain custom claim edits, and work the client action worklist and billing A/R worklist
  • Review and provide RCM weekly and monthly reports including productivity and financial reports as directed and complete action steps as necessary
  • Follow HIPAA guidelines when accessing and sharing patient information and maintain patient and business confidentiality
  • Provide timely and professional customer service, verify discrepancies by, and resolve patient billing issues, answer questions from patients, facility staff, and third-party vendors
  • Support additional coding, billing, and practice management projects as needed
Requirements:
  • High School Diploma, GED, or suitable equivalent
  • Coding Certification from APPC or AHIMA required
  • Minimum of one (1) year work experience as a Medical Coder and Medical Biller
  • Strongly Preferred: Minimum five (5) years medical coding and billing work experience working in healthcare; two (2) years medical coding and billing work experience with geriatric or home health populations
Working Conditions:

The work environment characteristics described here are representative of those an associate encounters while performing the essential functions of this job.

General office; automobile. Requires sitting and standing associated with a normal office environment.

Performs highly complex and varied tasks requiring independent knowledge and its application to a variety of situations, as well as exercising independent judgement.

This position will have remote work capabilities and must have the skill set to work independently, exercising sound judgment and maintaining high productivity levels.

Security and privacy training will be provided as part of this role to protect the confidentiality, integrity, and availability of PCS' associate and customer data.

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