Risk Billing Specialist - Hybrid

Complete Health•Jacksonville, FL

3h•$21 - $25•Hybrid

About The Position

The Risk Billing Specialist is responsible for ensuring all risk ICD-10 codes are properly documented with appropriate treatment plans on the encounter and that these specific risk codes are attached to the correct CPT code for all VBC plans. This role also ensures that claims are fully processed by the payor to receive the HCC diagnosis. The position involves daily key punching into the computer for accurate and timely billing, ensuring documentation and coding on the EMR are complete, and reviewing clinical documentation for accurate diagnosis and procedure codes according to CMS guidelines. The specialist will verify the appropriateness of ICD-10 codes, ensure pertinent diagnosis codes are on claims, and add dummy procedure codes when necessary. This role also includes communicating and educating providers on documentation, striving to enter charges within 3 business days, and daily review of postings before claim submission. Additional duties include closing batches, balancing money posted, entering cash receipts, submitting electronic claims, assisting with billing phone calls, resolving claim denials, entering penny charges for HCC codes, communicating with providers on claim documentation, and auditing/analyzing charts.

Requirements

High School Diploma or Equivalent
CPC Certification (or equivalent) required. CPC-A accepted
(2) Training or background in ICD-10 / CPT codes.
Knowledge of medical terminology and billing practices.
Ability to work under pressure.
Ability to handle multi-functions/multi-tasks.
Ability to problem solve and adapt to a fast paced work environment.
Pay attention to detail, function autonomously.
Ability to effectively communicate with the medical staff and Office Managers.
Knowledge of bookkeeping and office functions.
Knowledge of CPT and ICD10 codes.
Ability to work proficiently and efficiently on a timely manner.
Knowledge of all payer codes.

Nice To Haves

CPB Certification preferred
HCC Certification preferred
1-2 years of primary care billing experience preferred (outpatient/medical practice coding experience preferred)
Understanding of community-based organizations.
Knowledge of all programs offered by NHSI.

Responsibilities

Ensuring all risk ICD-10 codes are properly documented with appropriate treatment plans on the encounter.
Attaching specific risk codes to the correct CPT code for all VBC plans.
Making sure that the claim is fully processed by the payor so that they receive the HCC diagnosis.
Daily key punching into computer when needed to assure accuracy of billing for all services rendered in patients account in a timely manner.
Ensure completion of documentation and coding on the EMR when needed on charges entered in patient's accounts for a correct and complete billing claim.
Review clinical documentation and make sure accurate diagnosis codes and procedure codes are documented with the use of MEAT/TAMPER according to CMS guidelines.
Verify the appropriateness of the ICD-10 code to include required supporting documentation and treatment plans.
Make sure that all pertinent diagnosis codes go out on the claim and add Dummy procedure codes when necessary.
Communicate and Educate providers that are not correctly documenting Diagnosis and procedure codes.
Strive to make sure all charges are entered with in 3 business days.
Daily review of all postings before claim submission.
Daily closing of batches and balancing of money posted for VBC/ DCE patients.
Enter cash receipts if needed and assure correct allocations, distribution in accordance with the established protocol.
Responsible for submitting all electronic claims for VBC/DCE plans.
Responsible for assisting with Billing Phone calls for VBC/DCE patients if need to provide exceptional customer service to patients with billing related questions.
Resolving claim denials to VBC/DCE plans and issues with claims processing in a timely manner to ensure all claims and HCC codes are received and processed by payors.
Entering Penny Charges of HCC codes that did not reach the payor.
Effectively communicate with providers on claim documentation for charges submitted.
Effectively audit and analyze charts.