Risk Billing Specialist

Complete Health•Jacksonville, FL

5d•$22 - $25

About The Position

The person handling this position is responsible for ensuring all risk ICD-10 codes are properly documented with appropriate treatment plans on the encounter and these specific risk codes are attached to the correct CPT code for all VBC plans. This person is also responsible for making sure that the claim is fully processed by the payor so that they receive the HCC diagnosis.

Requirements

High School Diploma or Equivalent
CPC Certification (or equivalent) required
At least 5 years of billing and coding experience (outpatient/medical practice coding experience preferred)
(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
Understanding of community-based organizations.
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.
Knowledge of all programs offered by NHSI.

Nice To Haves

CPB Certification preferred
HCC Certification preferred
outpatient/medical practice coding experience preferred

Responsibilities

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.