Billing & Data Specialist

Arkansas Hospice, Inc.•North Little Rock, AR

3h•Onsite

About The Position

The Billing & Data Specialist is responsible for providing clerical support, guidance and to assign appropriate ICD-10-CM, CPT, and HCPCS code(s) to patient health information, as documented in the medical record for data retrieval, data analysis, and proper reimbursement. Support to the Arkansas Palliative Care & Arkansas Advanced Care program. Responsibilities include working on admissions, discharges and billing and various data collection activities in coordination with the APC & AAC clinical team and other Arkansas Hospice (AH) departments. Maintains records, performs data entry, and coordinates calendars for APC&AAC. The Billing & Data Specialist participates in other projects and functions as assigned not limited to education for providers. This position is responsible for all payors (Medicare, Patient Pay, Medicare Secondary Payor, and Commercial Insurance) as assigned and maintaining positive relations with commercial insurance carriers, obtaining authorizations from commercial insurance companies (including Medicare Advantage; as well, as primary and secondary), ensuring all medical management requirements are met for each commercially insured patient, and facilitating effective communication between the insurance company and APC & AAC regarding each patient’s care.

Requirements

High school diploma or GED.
CCS, CCS-P, CPC or CPC-A coding credential required.
A minimum of two (2) years of experience in a clerical role in a health care environment.
Must have experience in the assignment of ICD-10-CM, CPT, and HCPCS codes to medical record documentation.
Expert knowledge of coding principles and guidelines related to regulatory compliance.
Proficiency in Microsoft Office applications, including Word, Excel and PowerPoint.
Minimum typing speed of 45 wpm.
Must have valid driver’s license, automobile insurance, personal vehicle, and ability to travel between locations and work flexible hours.
Knowledge of basic computer software applications.
Excel knowledge.
Skill in organizing and prioritizing workloads to meet deadlines.
Ability to communicate effectively both orally and in writing.
Ability to communicate effectively with co-workers and other customers.
Ability to follow basic safety policies and procedures.
Ability to use good judgment and to maintain confidentiality of information.
Ability to work as a team player.
Ability to demonstrate tact, resourcefulness, patience and dedication.
Ability to accept direction and adhere to policies and procedures.
Ability to work in a fast-paced environment and manage multiple priorities.
Knowledge of nursing practice, documentation, and medical terminology.
Knowledge of insurance benefit plan design, eligibility and utilization/case management processes.
Ability to document in and retrieve information from the electronic medical record and billing system.
Ability to assess patients and interpret clinical information to ensure accurate and complete exchange of information with commercial insurance case managers.
Competent in the use of numeric and alphabetic filing systems.
Competent in the use of electronic medical records systems.
Knowledge of the billing process as it relates to coding for provider services in various settings.
Knowledge of medical terminology, anatomy and physiology.

Responsibilities

Completing all internal billing responsibilities for APC & AAC as assigned
Follows the process for patient pay. Which consists of contacting social workers to work with patient/families and processing the Financial Assistance Applications. Will process and send monthly statements, check to see if any patient pay accounts can be billed to probate, follow up on any outstanding patient pay accounts per Arkansas Hospice Policy.
Follows any changes to a patient’s account daily by reviewing and completing workflow in a timely manner. Also, review Coordination Notes and complete Administrative Tasks in the Electronic Medical Record (EMR).
Communicates with physicians’ offices, hospitals, insurance companies, and other providers to obtain required information on patient billing sources.
Handles confidential material with tact, diplomacy and discretion.
May need to educate clinical staff on the choice of appropriate ICD-10-CM codes based on their clinical documentation, in order to meet regulatory guidelines and support of maximum reimbursement. Discusses alternative codes and possible additional documentation as wells as educates staff, as needed.
Prior to admission, when at all possible, verifies insurance coverage, obtains authorizations, ensures fulfillment of any utilization management requirements.
Maintains documentation of all information gathered, contacts, and negotiations, and documents information required for patient care or billing in the EHR (electronic health record).
Assists with verifying that the correct CPT, HCPCS and ICD-10’s has been entered and maintained in the EHR appropriately. Different commercial insurance companies may require a different bill type, or a specific CPT or HCPCS code for payment, alongside HIM Coders
Reviews and assigns CPT codes to provider visits for all service lines, performs other duties as assigned.
Ensures compliance with all applicable state and federal laws, regulatory standards, contracts and organizational policies and procedures, etc.
Accepts direction and follows instructions from supervisor; seeks additional information as needed; works with minimal supervision.
Upon admission to an APC & AAC service, obtain the hospital or other facility Face Sheet if the patient is in a facility (or required demographic information for non-facility patients)
Coordinate with appropriate partner organization staff to ensure consult orders are in the partner organization’s EMR and the consult order is added
Verify APC clinician billing sheets are received in a timely manner, retrieve visit notes from the partner organization’s EHR, match notes to billing sheets, and code accordingly.
Maintain statistical database for APC & AAC and partner organizations by compiling and reconciling visit, quality and other data between systems for reporting purposes.
Capture PQRS, CAPC and other data (such as quality and performance metrics) through data mining and/or audits of the appropriate EHR; record and report data; enter data into appropriate system accurately and within specified timeframes.
Completes special projects as assigned by Supervisor, Director and CMO
Maintains strict confidentiality at all times.
Accepts direction and follows instructions from supervisor.
Adheres to all organizational and departmental policies and procedures.
Continually meets organizational standards for attendance and punctuality; notifies supervisor in a timely manner when employee will be absent or late for work.
Attends all required meetings and in services; seeks opportunities for additional professional development activities as appropriate.
Performs other duties as assigned.

Benefits

Medical, Dental, and Vision Insurance
Company paid life insurance policy up to $15,000
FSA and FSA Dependent care
Supplemental Insurance such as Short-term disability, Long-Term disability, etc.
401(k) retirement plan with company match
Paid time off (PTO) program to total up to 208 hours a year
Tuition and certification reimbursement for qualified employees
Employee Assistance Program (EAP).
Free parking at all locations.
Mileage reimbursement for company travel.