Biller/Coder- PT Physician Practices (Req #1336) - Full-time / Part-time

Position Summary :

This position is responsible for coding records by established guidelines to insure appropriate reimbursement is received. Code records by the appropriate coding scheme and verifies the accuracy of the data contained within the medical record. Oversees all aspects of patient billing processes to include charge entry, claim submission, payment posting, refunds, adjustments, denial follow-up, AR management, and reporting. Manages commercial insurance, private pay and industrial accounts. Answers billing questions taking into consideration allowable and Medicare guidelines. Promotes a team-oriented atmosphere and takes initiative in maintaining a tidy and safe clinical environment.

Essential Job Functions/ Duties

CODING PROCEDURE AND GENERAL DUTIES

Codes records by the appropriate coding scheme utilizing approved coding guidelines.

Retrieves and sequences complications and co-morbidity's from the records to insure the most appropriate reimbursement.

Communicates with the physicians on clarification of principal and secondary diagnoses in a timely and professional manner.

Accurately, enters pertinent billing and demographic information in to the electronic medical record.

Maintains a listing of records that require diagnoses and makes any necessary changes to alleviate this. Contacts the physician offices to obtain diagnoses or clarification on diagnoses in a timely and professional manner.

Communicates with the CBO Director on coding and reimbursement issues that need to be clarified. Additionally, informs the Manager &/or Director of potential risk management issues.

Enters and accesses data appropriately in the applicable the electronic medical record.

Meets productivity standards and deadlines.

Answer telephone and complies with requests from the various customers of the Central Business Office a timely and professional manner.

Assists physicians or healthcare professionals with chart completion by pulling records upon request in a timely and professional manner.

Works closely with Central Business Office staff to address coding issues that might impact account receivables.

Work with ancillary departments to help correct inappropriate modifier usage.

Assists with other billing duties as assigned.

Detail-oriented; sharp problem-solving skills; ability to multi-task

Serves as practice liaison to all outside billing-related entities

Promptly reports billing updates and/or issues to the AR Manager

Educates Front Office Clerks on billing guidelines as it relates to their duties

Maintain current knowledge of CPT and ICD-9 codes, billing policies and government and non-government plans

Completes payment posting and creates daily bank deposits tracking EFT's, ERA's and payments made over the phone

Routine follow-up on past due accounts (commercial insurance, private pay, and industrial)

Submits electronic claims daily and paper as needed

Timely follow up of insurance denials and appeals

Regularly audits insurance payments for proper reimbursement

Maintains daily cash log, transaction records completes daily, weekly and monthly reporting

Works eCW reports daily (i.e. -- No Guarantor, Unposted payments and Refunds)

Bills all industrial accounts, including lab, works with collection agency in posting bad debt adjustments and creates payment plans, offers private pay discounts per the financial policy

Position Requirements:

Education: High School diploma required. Must attend educational programs to maintain the required CE hours, Associates degree in related field or minimum 3 years clinic billing experience

Experience: Must have two to three years' experience within a physician office or other outpatient setting with emphasis on ICD-9-CM, CPT coding and the prospective payment system

Licensure: CPC certification required and Valid Virginia Driver's License.

Special Qualifications: CPC, CEMC or advanced certification preferred, 3 years clinic billing experience

Behavioral Requirements

Must possess excellent interpersonal skills, a positive attitude, willingness to learn, ability to speak clearly, communicate instructions in both oral and written forms.

Demonstrate the ability to work with patients, families, physicians, mid-level providers, peers, and administrative staff in a tactful and professional manner.

All employees are required to deliver quality care by providing excellent customer service and participate within a team centered approach in the Wythe Market Physician Practices at all times.

Technical Requirements

Demonstrate knowledge of ICD-9, ICD-10, CPT codes, insurance benefits and healthcare backgrounds.

Must display proficiency in EMR, order entry and other clinic and hospital systems.

Significant working knowledge of computers, telephones, copy and fax machines.

ECW and Meditech experience preferred .

Must adhere to policies, procedures and regulations as outlined in the clinic Policy and Procedure Manual. Must possess a high degree of accuracy for the performance of job-related tasks and functions.

5 years working in a medical facility; Family Medicine, Pediatrics, General & Vascular Surgery, OBGYN, Cardiology and/or Orthopaedics preferred

Proficient with Electronic Medical Records (EMR) systems (preferably eClinical Works), transmission clearinghouse systems (Emdeon, NaviCure, ePremis), Practice Management/Scheduling System(s)