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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 career with a dynamic organization that positively impacts the community? Positive Impact Health Centers is the ideal workplace for you.

About Us: Positive Impact Health Centers (PIHC) stands as a pivotal community resource in delivering HIV prevention, care, and treatment services within Metro Atlanta. Our comprehensive care model ensures that clients receive access to medical, pharmacy, dental, behavioral health, and social services, maximizing their chances of achieving optimal health outcomes. We provide services both on-site and through telehealth.

What We Offer:

  • Quarterly Health Wellness Days
  • Parental Leave
  • Complimentary parking and public transport accessibility
  • Competitive Salary and Benefits Package
  • Retirement Program with Automatic 3% Safe Harbor and 2% Profit Sharing
  • 100% of benefits for employees and 50% for spouses/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 complete information is gathered and reported 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 insurance providers and other payers.
  • Verification of code accuracy and sequencing in compliance with governmental and insurance standards.
  • Reviewing and analyzing medical records to ensure correct coding of diagnoses and procedures, following up with providers on any unclear documentation.
  • Assigning or reassigning CPT, HCPCS, and ICD-10-CM codes as necessary.
  • Maintaining a strong understanding of E/M Guidelines.
  • Following up on unpaid claims and initiating appeals for denied claims within standard billing cycles.
  • Monitoring claims progress through the clearinghouse and promptly resolving any issues.
  • Providing professional customer service, addressing patient billing inquiries, and resolving issues with patients, facility staff, and third-party vendors.
  • Reviewing insurance and patient aging reports.
  • Staying informed on healthcare regulations, medical terminology, and coding practices.
  • Adhering to HIPAA guidelines when accessing and sharing patient information.
  • Tracking, reviewing, and reporting on billing metrics, trends, and conducting periodic audits to ensure compliance and accuracy.
  • 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, answering calls and emails, managing inventory, and ordering supplies while adhering to all state, district, and agency policies regarding patient confidentiality.

Qualifications

Knowledge, Skills, and Abilities:

  • In-depth knowledge of insurance and reimbursement processes.
  • Strong mathematical and data entry skills.
  • Ability to exercise sound judgment and discretion.
  • Familiarity with HIPAA privacy regulations for patient information, maintaining confidentiality.
  • Proficient in computer use and standard office equipment.
  • Excellent verbal and written communication skills.
  • Basic understanding of medical ICD-10 codes and CPT billing codes.
  • Strong telephone and patient relationship skills.
  • Detail-oriented with the ability to prioritize tasks effectively.
  • Experienced billing specialists can work with minimal supervision.

Minimum Qualifications:

Associate degree (Bachelor's degree in business or related field preferred) and two years of experience as a Medical Biller/Coder in medical and behavioral health services.

Or

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

Licensure:

Certification in Billing/Coding is 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 to enable individuals with disabilities to perform essential functions.

While performing the duties of this position, the employee is frequently required to sit and communicate. Occasionally, the employee may need to walk, use hands to operate computers and tools, and reach with hands and arms. The employee must occasionally lift and/or move up to 30 pounds. Specific vision abilities required include close vision and the ability to adjust focus.

Notes:

  1. 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.
  2. Recreational drugs, weapons, and violence are strictly prohibited on agency property or during agency events.
  3. This job description represents the general nature, primary duties, and responsibilities of 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 with or without notice.
  4. 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 outlines the position at Positive Impact Health Centers. The work performed may vary, and while this document can be used for recruiting and staffing, it should serve only as a guideline for the qualifications and responsibilities associated with this role. Meeting the qualifications does not guarantee employment or promotion. Positive Impact Health Centers reserves the right to modify this document as necessary without prior notice.