Billing and Coding Specialist

Central Florida Health Care•Winter Haven, FL

About The Position

Under general supervision the position is responsible for billing, coding, posting, assigning correct payer sources, submitting clean claims to insurances and follow up for on denial claims in order to maximize the revenue cycle through billing and coding expertise. Reviews, analyzes and assures the final diagnoses and procedures as stated by the practicing providers are valid and complete. Train and educate staff regarding proper billing and coding practices.

Requirements

High School Diploma
Medical Coding Certificate – CPC or CCS certification required
Excellent interpersonal skills
Two years’ experience using ICD coding, CPT, HCPS or equivalency

Nice To Haves

Knowledge of billing practices required, FQHC preferred

Responsibilities

Assesses adequacy of health record documentation in order to support accurate, complete and specific assignment of modifiers, International Classification of Diseases (ICD), Current Procedural Terminology (CPT) and Health Common Procedural Coding (HCPC) codes to maximize reimbursement.
Reviews record to ensure that the appropriate billing provider, required attachments, signatures and other relevant documentation to reflect treatment and services rendered are presence as required.
Properly assigns and correct as warranted procedure, modifier and diagnosis codes supported by provider documentation.
Appropriately queries provider for clarification or additional documentation needed for processing a clean claim.
Generate and process claims from provider documentation to submit claims to appropriate payer in accordance with Medicare, Medicaid and Managed Care policies for proper reimbursement.
Researches and ensures corrections are made on denied claims due to missing or incorrect information.
Follows up with appropriate party as warranted regarding denials and payments.
Review claims in holding status to process claims in a timely manner.
Provides recommendations to Director of Revenue Cycle Management regarding accounts receivables, coding and billing practices
Attends seminars and in-services as required to remain current on coding issues
Maintains all mandatory in-services
Maintains compliance standards in accordance with the Compliance policies and the Code of Conduct.
Reports compliance problems appropriately.
Determine the final diagnoses and procedures stated by the physician or other health care providers are valid and complete.
Federal laws and regulations affecting coding requirements
Principles, practices and methods of current coding certificate required
Modern/Best office practices
Knowledge of billing practices required, FQHC preferred
Knowledge of medical records, E H R required
Extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes
Must have good math skills and effective communication skills
Perform coding work requiring independent judgement with speed and accuracy
Examining and verifying coding errors through audits
Required in-services
Communicating clearly and concisely, orally and in writing
Confidentiality
Ability to use the computer
Ability to work independently to accomplish assigned work in a timely manner
Ability to communicate with staff and the public, both in person and over the phone, in a tactful manner and under difficult situations
Understanding and carrying out verbal and written directions
Follow CFHC policies and procedures
Works independently in the absence of supervision
Performs other related duties, which may be inclusive, but not listed in the job description

Benefits

Competitive Salary
Federal Student Loan Forgiveness: PSLF – 10-year commitment, 120 loan payments and at the end of the commitment, the remaining loan is forgiven
Excellent medical, dental, vision, and pharmacy benefits
Employer Paid Long-Term Disability Insurance
Employer Paid Life Insurance equivalent to 1x your annual salary
Voluntary Short-Term Disability, additional Life and Dependent Life Insurance are available
Malpractice Insurance
Paid Time Off (PTO) – 4.4 weeks per year pro-rated
Holidays (9.5 paid holidays per year)
Paid Birthday Holiday
CME Reimbursement
401k Retirement Plan after 1 year of service (w/matching contributions)
Staff productivity is recognized and rewarded