Medical Coding and Billing Specialist

6 days ago

Westminster, Colorado, United States Adams County, CO Full time

Job Summary

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The Revenue Cycle Medical Billing and Coding Specialist plays a vital role in our team, ensuring the efficient processing of medical claims, maintaining accurate patient information, and providing exceptional customer service to internal and external stakeholders. This position requires strong attention to detail, excellent communication skills, and a commitment to delivering high-quality results.

Key Responsibilities:

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  • Primary point of contact for claim submissions, scrubbing, and reconciliation of denials.">
  • Collections, 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 the general ledger.">
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Billing Systems Maintenance:

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  • Serves as liaison with insurance providers to maintain the most current fee schedules.">
  • Provides updates to Nursing Informatics to maintain current CPT, ICD-10 reimbursement in Electronic Medical Record.">
  • Maintains current fee schedule.">
  • Ensures 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 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 preparing bank deposits, running reports, completing pre-authorizations, and eligibility checks.">
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Credentialing:

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  • Maintains individual provider and nurse files to include up-to-date information needed to complete the required governmental and commercial payer credentialing applications.">
  • Maintains internal provider and nurse grid to ensure all information is accurate and logins are available.">
  • Updates each provider's CAQH database file timely according to the schedule published by CMS.">
  • Applies for and renews annually all provider licenses; Professional, DEA, Controlled Substance.">
  • Completes revalidation requests issued by government payers.">
  • Completes credentialing applications to add providers to commercial payers, Medicare, and Medicaid.">
  • Completes re-credentialing applications for commercial payers.">
  • Credentials new providers and re-credentials current providers with hospitals at which they hold staff privileges.">
  • Maintains accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.">
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Estimated Salary Range: $25.43/hour - $35.60/hour

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This position requires a strong understanding of State, Federal, and commercial health insurance coverage, medical coding using ICD 11, CPT, HCPCS, and modifiers, AR and Aging Analysis, Revenue Cycle Management, and HIPAA client confidentiality.

About Us:

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We are Adams County Public Health, a leading healthcare organization dedicated to providing exceptional services to our community. We value our employees' contributions and offer a dynamic work environment that promotes growth, learning, and teamwork.

Requirements:

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  • Three years of medical billing and medical coding experience, including at least one year of 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.">
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Education & Training:

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  • 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.">
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Working Conditions and Physical Requirements:

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This position involves sitting for 90% of the time and standing or walking for 10% of the time. The employee must occasionally lift, carry, pull, or push up to 20 lbs and use cart, dolly, or other equipment to carry in excess of 20 lbs.

Background Check:

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Must pass a criminal background check.

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