Healthcare Billing and Coding Specialist

2 weeks ago


Napa, California, United States HCMS Napa LLC Full time
Job Overview

Position Summary:

The Healthcare Billing and Coding Specialist collaborates closely with the Revenue Cycle Director to guarantee that the coding and abstraction of medical documentation are performed accurately, thoroughly, and efficiently. This role requires a professional with extensive experience in both diagnostic and procedural medical coding and billing, with a preference for candidates who have surgical coding experience.

Qualifications:

  • Minimum of 2 years in Medical Billing (preferred)
  • Coding Certification (CPC) with at least 2 years of experience (required)
  • Comprehensive understanding of Revenue Cycle operations, including charge capture, health information management, billing, collections, denials, and bad debt.
  • Proficient knowledge of CPT, HCPCS, ICD-9/ICD-10 codes, CMS 1500 claim forms, HIPAA regulations, billing and insurance guidelines, medical terminology, insurance benefits, and the appeals process.
  • Required software proficiency: Microsoft Windows, Microsoft Office (Word & Excel), and medical billing software.
  • Detail-oriented with the ability to manage frequent interruptions and distractions.
  • Strong mathematical, written, and verbal communication skills.

Benefits:

  • Generous Paid Time Off
  • Retirement Plan
  • Supportive and enthusiastic work environment
  • Career growth opportunities

Key Responsibilities:

  • Support the billing department's operations, including coding, charge entry, and claims submissions.
  • Analyze billing and claims for accuracy and completeness; submit claims to appropriate insurance entities and resolve any submission issues.
  • Stay updated on current coding and billing regulations and compliance requirements.
  • Maintain knowledge of health information management issues, including HIPAA and relevant health regulations.
  • Adhere to billing guidelines and established policies and procedures.
  • Ensure confidentiality of patient and client-related information.
  • Foster effective working relationships with team members, clients, staff, and patients.
  • Extract information from medical records and assign appropriate codes as necessary.
  • Prepare and submit claims to third-party insurance carriers, either electronically or via hard copy.
  • Post charges, payments, and adjustments accurately.
  • Understand insurance benefits, including copays, deductibles, and coinsurance.
  • Collaborate with internal providers and external facilities to obtain necessary documentation for coding claims.
  • Investigate rejected and denied claims.
  • Apply medical terminology, ICD-10, CPT-4, and HCPCS coding guidelines and payer rules effectively.
  • Work with physicians and other stakeholders to ensure complete and accurate information for optimal reimbursement.
  • Read, interpret, and enter information into the facility's database using medical coding protocols to generate statements or claims.
  • Conduct audits and generate data reports for supervisory review.
  • Perform other related duties as assigned.


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