Healthcare Billing and Coding Expert

1 week ago

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

Are you looking for a fulfilling role within a dynamic organization that positively impacts the community? Positive Impact Health Centers is the ideal workplace for you.

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 access to medical, pharmacy, dental, behavioral health, and social services, facilitating optimal health outcomes. Services are delivered both on-site and via telehealth.

What sets us apart? We provide our employees with:

  • Quarterly Health Wellness Days
  • Parental Leave
  • Complimentary parking and accessible public transport
  • Competitive Salary and Benefits
  • Retirement Program with Automatic 3% Safe Harbor and 2% Profit Sharing
  • 100% of benefits for employees and 50% for dependents
  • Access to a Credit Union

*Covid-19 vaccination proof is mandatory*

Position Summary

The Medical Billing & Coding Specialist is responsible for ensuring the accuracy and completeness of information submitted to private insurance, Medicare, and Medicaid, thereby supporting the revenue cycle. This role involves verifying coding accuracy 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 third-party billing.

Key Responsibilities

Core Duties:

  • Timely and accurate submission of medical claims to insurance providers and other payers.
  • Ensure proper coding and sequencing in compliance with governmental and insurance standards.
  • Review and assess medical records to confirm correct coding of diagnoses and procedures, collaborating with providers on any unclear documentation.
  • Assign or adjust CPT, HCPCS, and ICD-10-CM codes as necessary.
  • Maintain a strong understanding of Evaluation and Management (E/M) Guidelines.
  • Follow up on unpaid claims and initiate appeals for denied claims within standard billing timelines.
  • Monitor claims progress through the clearinghouse and promptly resolve any issues.
  • Deliver timely and professional customer service, addressing patient billing inquiries and issues.
  • Review aging reports for insurance and patient accounts.
  • Stay informed on healthcare regulations, medical terminology, and coding practices.
  • Adhere to HIPAA guidelines when handling patient information.
  • Track, analyze, and report on billing metrics and trends to ensure compliance and accuracy.
  • Maintain adherence to all regulatory and accrediting standards.
  • Perform additional job-related duties as assigned.
Additional Duties

Conduct general office tasks such as typing, filing, photocopying, report generation, and managing communications. Ensure compliance with all relevant policies regarding patient confidentiality.

Essential Knowledge, Skills, and Abilities
  • Understanding of insurance and reimbursement processes.
  • Proficient in data entry and mathematics.
  • Ability to exercise sound judgment and discretion.
  • Familiarity with HIPAA privacy regulations.
  • Competent in using computers and standard office equipment.
  • Strong verbal and written communication skills.
  • Basic knowledge of ICD-10 and CPT medical billing codes.
  • Excellent telephone etiquette and patient relationship management.
  • Detail-oriented with effective prioritization skills.
  • Experienced billing specialists should be capable of working independently.
Qualifications

Minimum Requirements:

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

Or

Any equivalent combination of training and experience (via AAPC or similar curriculum) that provides the necessary knowledge, skills, and abilities.

Licensure

Certification in Billing and Coding required.

Physical Requirements

The physical demands outlined here represent those that must be met by an employee to successfully perform the essential functions of this role. Reasonable accommodations may be made for individuals with disabilities.

While performing the duties of this position, the employee is frequently required to sit, talk, or hear. Occasionally, the employee must walk, use hands to operate computers and other tools, and reach with hands and arms. The employee may occasionally lift and/or move up to 30 pounds. 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 against any employee or applicant 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 at agency events.
  • This job description outlines the general nature, primary duties, and qualifications for this position but is not an exhaustive list. Employees may be required to perform other duties as assigned, and specific responsibilities may change at any time.
  • Where permitted by law, candidates must have received or be willing to receive the COVID-19 vaccine by the date of hire to be considered for employment.

Purpose Statement

This document provides descriptive information about the position at Positive Impact Health Centers. Work performed by incumbents may vary. This document serves as a guideline for recruiting and staffing but does not guarantee employment or promotion. Positive Impact Health Centers reserves the right to modify this document as necessary.

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