Revenue Cycle and Coding Specialist (Hybrid Role in Austin TX)

Central Health•Austin, TX

2d•Hybrid

About The Position

Under the supervision of the Revenue Cycle Supervisor, this role is responsible for various revenue cycle functions including coding/edit charge review, accurate and timely submission of insurance claims, failed claims/follow-up resolutions, training, education, research, denial appeals, resolving unpaid medical claims, cash posting, and processing billing calls and inquiries. The specialist may also serve as an intermediary between healthcare providers, clients, patients, and health insurance companies. This position adheres to internal coding policies and management expectations, acting as a trainer and resource. Key duties involve reviewing clinical documentation to assign appropriate ICD-10, CPT, HCPCS, and other relevant codes, ensuring alignment with services rendered and documented in patient records. Adjustments to codes are made when discrepancies are identified, and collaboration with healthcare providers occurs to clarify documentation and coding. Adherence to coding guidelines from AHIMA and AAPC is mandatory. The role processes accurate code assignments for claims and required billing data elements prior to payment and revenue reporting, ensuring compliance with Medicare, Medicaid, and third-party payer guidelines. Accurate posting from remits is crucial for proper work queue routing and accounting.

Requirements

4 years of experience in medical coding, medical auditing, or billing, in multi-specialty outpatient/professional billing setting
Certified Coding Specialist (CCS) through governing body AHIMA OR Certified Coding Specialist ‐ Physician (CCS‐P) through governing body AHIMA OR Certified Professional Coder ‐ (CPC) through governing body AAPC.
Knowledge of revenue cycle, billing and collections processes and procedures.
Demonstrated knowledge of Epic or other medical billing software.
Demonstrated knowledge of ICD‐10, CPT and HCPCS coding.
Demonstrated knowledge of Medicare, Medicaid, and other third-party insurers.
Demonstrated knowledge of policies, procedures/rules, and regulations used in interpreting proper billing and coding processes and techniques.
Attention to detail and accuracy.
Verbal and written communication skills.
Skill at building relationships and providing excellent customer service.
Demonstrated proficiency and experience in the use of computer and commonly used software including but not limited to Microsoft Office Suite, electronic medical record or practice management system.
Ability to multitask.
Must live in the greater Austin/Travis County area

Responsibilities

Ensure accurate and timely billing and collection of medical claims.
Conduct chart reviews on documentation and correct coding to ensure compliance with all governmental and contractual obligations.
Working with Supervisor and the Compliance office, train providers in proper documentation and coding as indicated by chart review.
Performs charge review, claim edits, and ensuring the accurate and timely CPT/ICD coding for all clinical provider charges.
Process all charges and reviews and clear all coding edits generated by EMR/PM.
Clears all errors and edits generated by EMR and PM system.
Perform complex tasks relating to insurance verification, resolution of aging accounts, resolution of patient complaints and client customer service.
Assist with process improvement to maximize patient experience and reimbursement.
Process insurance payments, reconciling deposits, posting payments and recoupments, and managing patient accounts.
Ensures accurate posting from remits to ensure proper work queue routing and required billing data elements to ensure an accurate accounting processed for payment and revenue reporting.
Answer and resolve patient inquiries from internal and external sources.
Serve as an intermediary between healthcare providers, patients, health insurance companies and other stakeholders.
Participate in special projects and complete other duties as assigned