Medical Billing, Coding and Denial Specialist

MicroHealth, LLC•Vienna, VA

19h•Remote

About The Position

MicroHealth is seeking an experienced Medical Billing, Coding and Denial Specialist with CareView (or similar EHR) experience to provide hospital medical billing and coding support services. This position will ensure accurate clinical coding and timely preparation and submission of hospital medical billing claims for both inpatient and outpatient hospital services. The specialist will operate as an extension of customer's current medical billing and coding team, working remotely based on operational needs. Incumbent will work rotating shift.

Requirements

Minimum 7 years of hospital medical billing and coding experience
Extensive experience with Emergency Room (ER) medical billing and coding
Required system experience with one or more of the following: CareVue, VISTA (Veterans Health Information Systems and Technology Architecture), CPRS (Computerized Patient Record System)
Familiarity with hospital billing systems and clearinghouses
Electronic claims submission experience
Comprehensive knowledge of Medicare and Medicaid billing requirements
Proficiency in ICD-10-CM diagnosis and procedure coding
Proficiency in CPT/HCPCS coding
Experience with UB-04/837I institutional claim formats & CMS-1500/837P professional claim formats
Knowledge of APC (Ambulatory Payment Classification) assignment

Nice To Haves

5+ years of demonstrated experience in supervisory role of hospital setting highly desirable
Active certification as CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) preferred

Responsibilities

Assign accurate and compliant ICD-10-CM diagnosis codes for inpatient encounters
Assign accurate and compliant ICD-10-PCS procedure codes
Review physician documentation for completeness and accuracy
Identify complications and comorbidities (CC/MCC) to ensure appropriate DRG assignment
Query physicians for documentation clarification when necessary to support accurate coding
Ensure compliance with all applicable coding guidelines including Official Guidelines for Coding and Reporting
Assign accurate CPT/HCPCS codes for outpatient services
Assign accurate ICD-10-CM diagnosis codes for outpatient encounters
Perform APC assignment for outpatient services
Code observation services in compliance with CMS guidelines
Code emergency department encounters with appropriate E/M levels
Code same-day surgery procedures
Code outpatient diagnostic services (radiology, laboratory, cardiology, etc.)
Review encounter/charge data for completeness prior to claim submission
Prepare UB-04/837I institutional claims and CMS-1500/837P professional claims
Validate all coding assignments and charges against documentation
Validate critical data elements including: Member/patient identification numbers, National Provider Identifier (NPI) numbers, Provider taxonomy codes, Procedure modifiers, Units of service, Attending and operating provider information
Verify compliance with payer-specific rules and requirements
Perform claims formatting and compliance checks
Submit claims electronically through designated clearinghouse or billing system
Ensure timely electronic submission of claims within 48-72 hours of receiving complete information
Monitor claim acceptance or rejection status
Correct and resubmit rejected claims within 48 hours of notification
Maintain compliance with payer filing limits and timely filing deadlines
Manage clearinghouse transactions and resolve transmission issues
Review and analyze claim denials and rejections
Identify root causes of denials (coding errors, documentation deficiencies, registration issues, etc.)
Correct coding or billing errors and resubmit claims
Prepare appeals with supporting documentation when appropriate
Track denial trends and recommend process improvements
Work collaboratively with clinical documentation improvement (CDI) staff to address documentation issues
Maintain 95% patient billing accuracy rate
Ensure all coding and billing activities comply with: CMS regulations and guidelines, Medicare and Medicaid billing requirements, NCCi edits and bundling rules, Payer-specific policies and guidelines, HIPAA Privacy and Security Rules, HITECH Act requirements, GMHA privacy and security policies
Participate in coding audits and quality assurance reviews
Stay current with coding updates, regulatory changes, and payer policy modifications
Complete continuing education requirements to maintain certifications
Document all coding decisions, queries, and claim corrections
Communicate effectively with physicians, clinical staff, and revenue cycle team members
Provide coding education and guidance to clinical staff as needed
Participate in team meetings and case reviews
Maintain accurate records of work performed and productivity metrics