Medical Billing Coding Specialist

Location:

Appleton, WI

Position is 100% on-site

Hours:

36 hours a week

Hours are 8am-5pm

Pay:

depends on experience

Description:

The Medical Billing and Coding Specialist is a key position in the Revenue Cycle that manages the claim process, including accurate and timely claim creation, follow-up and correspondence with providers, insurance inquiries/correspondence. This position will assist in the clarification and development of process improvements and inquires, assure payment related to patient services from all sources are recorded and reconciled timely to maximize revenues. Other important duties include coding, credentialing, and resolving claim issues and denials.

Evaluate medical record documentation and coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflects and supports visits and to ensure that data complies with legal standards and guidelines.

Interprets medical information such as diseases or symptoms and diagnostic descriptions and procedures to accurately assign and sequence the correct codes.

Reviews all claims for completeness and accuracy before submission to minimize claim denials

Evaluates records and prepares reports on topics such as the number of denied claims or documentation or coding issues for review by management and/or committees

Makes recommendations for changes in policies and procedures; updates procedures to maintain standards for correct coding to minimize the risk of fraud and abuse, and to optimize revenue recovery.

Provides technical guidance to physicians and other staff in identifying and resolving issues or errors such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, and/or codes that do not conform to coding principles/guidelines

Reads bulletins, newsletters, and other periodicals to stay abreast of issues, trends, and changes in laws and regulations governing medical record coding and documentation

Educates and advises staff on proper code selection, documentation, procedures, and requirements

Identifies training needs and conducts training to staff as needed to improve skills in the collection and coding of quality health data

Submits claims to a variety of payment sources, including Medicaid and Medicare, and other third-party payers. Prepares, reviews, and transmits claims using EPIC, including electronic and paper claim processing.

Maintains communication with patients and third-party payers until accounts are paid or referred to another appropriate agency for further collection activity.

Posts payments from both patients and third-party payers to patient accounts

Verifies insurance reimbursements for accuracy and compliance with contract discounts

Contacting insurance companies regarding any discrepancies and or denials

Identifies and coordinates the billing of secondary or tertiary insurances

Coordinates collection process, to include any projects with a collection agency and financial counselor

Manages daily statement process, including reviewing statements before sending and fielding any patient inquiries

Coordinates and administers policy and procedure for payment plans and auto-pay patients

Collaborates and works with front desk staff to ensure appropriate collection of self-pay, copay, and balance due

Handles patient inquiries as well as questions from other staff and insurance companies

Identifies and resolves any patient billing related problems, denials, and insurance company follow up

Oversee patient accounts and process refunds as necessary

Audits current procedures to monitor and improve the efficiency of the revenue cycle by making recommendations for process improvement (billing and collections operations).

Ensures that the activities of the billing and collections operations are conducted in a manner that is consistent with overall department protocol, and compliant with Federal, State, and payer regulations, guidelines, and requirements.

Analyzes trends impacting charges, coding, collection, and accounts receivable and makes recommendations for improvement.

Understands and remains updated with current medical accounts receivable and billing regulations and compliance requirements.

Maintains working knowledge of all health information management issues such as HIPAA and all health regulations.

Coordinates provider enrollments in all commercial, state, and federal insurance programs with Management and correspond to payer requests for updates to information

Provide data and support to Management as needed

Additional Skills & Qualifications:

Associates degree in accounting, business, finance, medical billing, or related field, preferred. Also preferred is experience with an electronic medical record system, especially Epic.

Two (2) years Medical Insurance/Healthcare Billing, Prior Authorization and Collections experience in a medical practice or health system, with a deep understanding of medical billing rules and regulations. A combination of education and experience will be considered.

Experience working with a variety of medical payers including Medicare, Medicaid, and commercial insurance

Experience working with EPIC

Working knowledge of CPT, ICD-9 & ICD-10, ANSI coding systems; coding certification preferred, but not required

About TEKsystems:

Were partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. Thats the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.