Billing and Coding Specialist (FT)

WVU Medicine

76d

About The Position

Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position. Reviews waiver budget variances by actively monitoring and completing financial analysis for anchor budget and addendum purchasing submission. Reviews coding and billing practices at United Summit Center to ensure consistency and compliance across the organization. Communicates with clinical staff to address holds, anchor dates and large budget variances accurately and timely. Effectively monitors and tracks issues and concerns to develop process improvement opportunities. Effectively monitors and tracks ever-changing coding practices and develops process improvement opportunities. Trainings and advises staff on coding processes and information. Acts as liaison between Billing Department and IT.

Requirements

• High school graduate or equivalent.
• State criminal background check and Federal (if applicable), as required for regulated areas.
• One (1) year of medical billing experience.

Nice To Haves

• Waiver billing experience.
• System billing experience.
• Finance experience.

Responsibilities

• Provide data insights for the purpose of Waiver budget creation, update and maintain waiver budget reconciliation tool, and create pivot tables for IDD waiver budget review.
• Monitor team Dash Board update and manage team SharePoint.
• Filter Tickets in billing system prior to sending the information to IT.
• Conduct billing system configuration insight and repair by partnering with IT and create work flow instructions for billing system.
• Monitor monthly waiver billings against projected monthly budgets to assure current residential schedules agree to actual billings and partners with case managers to resolve issues.
• Perform random audit functions (billing vs payroll) for non-24 hours client members.
• Identify all patients requiring pre-certification or pre-authorization at the time services are requested or when notified by another hospital or clinic department.
• Follow up on accounts as indicated by system flags.
• Contact insurance company or employer to determine eligibility and benefits for requested services.
• Follow up with the patient insurance company or provider if there are insurance coverage issues in order to obtain financial resolution.
• Use work queues within the designated EMR or appropriate system for scheduling, transition or care, and billing edits.
• Perform medical necessity screening as required by third party payors.
• Document referrals/authorizations/certification numbers in the designated EMR.
• Communicate with the patient the anticipated self-pay portion co-payments/deductibles/co-insurance, and account balance refers self-pay, patients with limited or exhausted benefits to the in-house Financial Counselors to determine eligibility.
• Maintain current knowledge or major payor payment provisions and regulations and participate in educational programs to meet mandatory requirements and identified needs with regard to the job.
• Assist Patient Financial Services with denial management issues and will appeal denials based on medical necessity as needed.
• Analyze patient charts carefully to know the diagnosis and represent every item with specific codes.
• Collect health information as documented by clinicians and code appropriately.
• Communicate with clinicians for further clarification and understanding of items on patient charts to avoid any misinterpretations.
• Provide accurate answers to queries on coding.
• Ensure that codes tally with clinicians’ diagnosis.
• Advocate for patients where their medical history is needed as evidence.
• Collect and distribute coding related information and billing issues to UM, Billing department, and Clinicians.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED
• Number of Employees: 101-250 employees