RHC Billing/Coding Specialist

Description

POSITION SUMMARY:

Under the direction of the Revenue Manager for Lake Area Medical Associates, this position will be responsible for ensuring quality, productivity, and an even flow of work daily. The RHC Billing Specialist will have quick typing skills, an analytical mind, exceptional attention to detail, and a passion for precision.

PRINCIPAL JOB DUTIES AND RESPONSIBILITIES

1. Adheres to all Organization policies and procedures.

2. Knowledge of insurance, including HMO/PPO, Medicare, Medicaid, Managed Medicare, and Managed Medicaid rules and guidelines. 

3. Interpreting EOBs for verifying the accuracy of insurance payer payments, adjustments, and denials. 

4. Accurately follows coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies. 

5. Assigns appropriate ICD-10 codes.

6. Assigns appropriate Modifiers, CPT, and HCPCS.

7. Initiating appeals for denied claims.

8. Preparing, reviewing, and transmitting claims using billing software, including electronic and paper claim processing. 

9. Checking each insurance payment for accuracy and compliance with contract discount.

10. Work DNFB and Aging reports for RHC.

11. Responsible for the timely and accurate posting of all payments and other postings.

12. Performs AR Follow-up.

13. Reviews accounts for outsourced collections.

14. Makes collection phone calls.

15. Assists patients with setting up payment plans.

16. Performs reports as needed.

17. Adheres to AHIMA Ethical coding guidelines. 

18. Adheres to CPT and HCPC coding guidelines. 

19. Answer patient and patient portal billing questions.

20. Demonstrates professionalism and accountability.

21. Demonstrates a caring attitude consistent with Cleveland Area Hospital toward patients, family members, employees, and other facility guests.

22. Demonstrates excellent communication skills. 

23. Performs other related duties which may be inclusive but not listed in the job description. 

EQUIPMENT: 

Computer and Printer

Copy Machine

Fax Machine

Telephone

Requirements

EDUCATIONAL/SKILLS REQUIRED:

High School diploma or GED required. Associate’s degree preferred. 

Excellent interpersonal skills. 

Knowledge of medical records, EHR preferred. 

Knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes.

Must have strong math and communication skills. 

Performing billing work requiring independent judgment with speed and accuracy. 

Communicating clearly and concisely, orally and in writing. Confidentiality. Ability to use the computer. Ability to work independently and to accomplish assigned work in a timely manner.

Ability to communicate with staff and the public, both in person and over the phone, in a tactful manner and under difficult situations. Understanding and carrying out verbal and written directions. Work independently without supervision. Working knowledge of all equipment, basic computer skills, and demonstrated skill in employee relations and problem-solving. Able to interact with a wide variety of individuals and handle multiple complex situations simultaneously. Evidence of leadership, integrity, and initiative.  

EXPERIENCE:

• 2-3 years of Rural Health Clinic billing experience preferred
• Preferred experience in Athena and Cerner hospital software.

RESPONSIBILITY FOR CONFIDENTIAL INFORMATION:

This position may have access to patient confidential records and must comply with HIPAA regulations and Compliance Policies.

WORKING CONDITIONS – PHYSICAL DEMANDS:

This position requires the following physical demands

Occasional = 33% Frequent = 66% Continuous = 100%

Occasionally, they must be able to be on their feet walking, standing, transporting, and/or positioning patients.

Occasional lift and transfer a minimum of 25 pounds and apply a minimum of ____pounds of push/pull force while using good body mechanics. 

Frequently use hands to finger, handle, or feel. 

Frequently reach with hands and arms. 

Occasionally requires bending and stretching while using good body mechanics.

May be exposed to communicable diseases.

The above statements reflect the general details considered necessary to describe the principal function of the job as identified, and shall not be considered as a detailed description of all work requirements that may be inherent to this position.

EEO STATEMENT:

Cleveland Area Hospital/Lake Area Medical Associates is an equal opportunity employer and considers all qualified applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and all other protected classes.