Job Detail

• Ensures timely and accurate processing of claims in a manner that is consistent with healthcare industry best practices
• Researches, abstracts, and communicates federal, state, and payer documentation, billing and coding rules and regulations
• Stays current with Medicare, Medi-Cal and other third-party rules and regulations including public programs such as FPACT, CPT updates, and ICD coding
• Serves as a liaison between billing staff and providers
• Performs scheduled and unscheduled independent chart reviews to ensure billing compliance of professional services billed through Neighborhood Healthcare, including eligibility, accuracy and adequacy of documentation, and coding related to FQHC and program billing
• Develops, implements, and consistently seeks improvement in policies and procedures for all billing and reimbursement functions to ensure department activities are carried in accordance with industry standards and optimizes revenue
• Develops and provide New Provider Orientation Billing and Coding training to new team members
• Ensures billing and coding compliance with industry standards, regulations, and company policy and procedures
• Ensure charge capture are accurate and submitted in a timely manner
• Responsible for making sure all claims have the appropriate documentation before being coded and claims submitted; follow-up with teams on insufficient documentation
• Assists department with research of claims not paid and other duties assigned
• Reviews medical chart notes and encounters for accuracy in CPT, HCPCS, ICD10 coding
• Posts charges & payments as needed
• Works on special temporary billing projects and claim filing as needed
• Documents all communications and activities in billing and financial notes to assist with clear, concise, and accurate communication to all who work with patients billing ledgers and processes
• Identify error trends or missed coding opportunities and use as an educational tool for the provider(s)
• Assists with annual superbill review and update with CPT and ICD-10 codes
• Works collaboratively with the appropriate operational leaders to develop provider education strategies to promote complete and accurate clinical documentation and non-compliance trends
• Develops chart review tool(s) to track and monitor chart review outcomes. Summarizes outcomes and reports them to the Director and/or the Management team(s)
• Assists the compliance program with federal, state and other special investigations and chart reviews.
• Other duties as assigned

Education/Experience

• High school diploma/GED required; bachelor’s degree in healthcare preferred
• Two years of CPT, ICD-10 coding systems, and chart review experience or equivalent combination of education and experience is required
• Current Certified Coding Specialist (CCS), Certified Procedural Coder (CPC) or equivalent is required
• Experience educating healthcare providers regarding coding, charting, and other relevant processes is preferred

Additional Qualifications (Knowledge, Skills and Abilities)