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Healthcare Billing and Coding Expert

2 months ago

Decatur, Georgia, United States Positive Impact Health Centers INC Full time
Job Overview

Are you looking for a fulfilling role in a progressive organization where you can contribute positively to the community? Positive Impact Health Centers is the ideal workplace for you.

About Us: Positive Impact Health Centers (PIHC) stands as a prominent provider of HIV prevention, care, and treatment services in Metro Atlanta. Our comprehensive care model ensures that clients receive integrated medical, pharmacy, dental, behavioral health, and social services, enhancing their chances of achieving optimal health outcomes. We offer services both on-site and through telehealth platforms.

What We Offer:

  • Quarterly Health Wellness Days
  • Parental Leave
  • Complimentary parking and accessible public transport options
  • Competitive Salary and Benefits Package
  • Retirement Program with Automatic 3% Safe Harbor and 2% Profit Sharing
  • Generous benefits allocation for employees and their dependents
  • Access to a Credit Union

*Covid-19 vaccination proof is mandatory*

Position Summary:

The Medical Billing & Coding Specialist is responsible for ensuring that accurate and comprehensive information is gathered and submitted to private insurers, Medicare, and Medicaid, facilitating the revenue cycle process. This role involves reviewing encounters for precise coding before claim submission, addressing claim denials, and securing pre-authorizations for specific procedures. A solid understanding of insurance regulations and medical coding is essential to optimize accurate third-party billing.

Key Responsibilities:

  • Timely and accurate submission of medical claims to various payers
  • Verification of correct coding and sequencing in line with insurance and government regulations
  • Reviewing medical records to confirm appropriate coding of diagnoses and procedures, and following up with providers on any unclear documentation
  • Assigning or adjusting CPT, HCPCS, and ICD-10-CM codes as necessary
  • Maintaining knowledge of E/M Guidelines
  • Following up on unpaid claims and initiating appeals for denied claims within standard billing cycles
  • Monitoring claim progress through the clearinghouse and addressing any issues promptly
  • Providing professional customer service to resolve patient billing inquiries and issues
  • Reviewing insurance and patient aging reports
  • Staying informed on healthcare regulations, medical terminology, and coding practices
  • Adhering to HIPAA guidelines when handling patient information
  • Tracking, analyzing, and reporting on billing metrics and compliance audits
  • Ensuring compliance with all regulatory and accrediting bodies
  • Performing additional job-related duties as assigned

Additional Duties:

General office tasks such as typing, filing, photocopying, report generation, and managing communications. Adhering to confidentiality policies regarding patient information is crucial.

Qualifications:

  • Knowledge of insurance and reimbursement processes
  • Strong math and data entry skills
  • Good judgment and discretion
  • Familiarity with HIPAA privacy standards
  • Proficient in computer usage and office equipment
  • Effective verbal and written communication skills
  • Basic understanding of ICD-10 and CPT coding
  • Excellent telephone and patient interaction skills
  • Detail-oriented with the ability to prioritize tasks
  • Experienced billing specialists can work with minimal supervision

Minimum Requirements:

Associate degree (Bachelor's degree in business or related field preferred) and two years of experience in medical billing/coding for healthcare services.

Alternatively, any equivalent combination of training and experience that provides the necessary knowledge, skills, and abilities.

Licensure:

Certification in Billing/Coding is required.

Physical Requirements: The physical demands of this position include frequent sitting and communication. Occasional walking and the ability to handle office equipment are necessary. The employee may need to lift up to 30 pounds occasionally. Specific vision abilities required include close vision and the ability to adjust focus.

Notes:

  • Positive Impact Health Centers, Inc. is an equal opportunity employer and does not discriminate based on race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, or veteran status.
  • Recreational drugs, weapons, and violence are prohibited on agency property and during agency events.
  • This job description outlines the primary duties and responsibilities of this position but is not exhaustive. Employees may be required to perform other duties as assigned.
  • Where permitted by law, candidates must have received or be willing to receive the COVID-19 vaccine by the start date to be considered for employment.

Purpose Statement:

This document provides an overview of the Medical Billing and Coding Specialist position at Positive Impact Health Centers. The work performed may vary, and while this document serves as a guideline for qualifications and responsibilities, it does not guarantee employment or promotion. Positive Impact Health Centers reserves the right to modify this document as necessary.