Job Announcement: HR2023:23
Position Title: Outpatient Coder/Billing Specialist
Advertising: Publicly Department: Health
Division: Health & Elder Services
Immediate Supervisor: Revenue Director
Department Director: Director-Health
Employment Status: Non-Exempt
Position Type: Regular Full–Time
Mandatory Reporter: Yes
Background Check Required: Yes (data-sensitive)**
Opening Date: Monday, January 30, 2023
Closing Date: Open Until Filled
Preference shall be given in accordance with the Title 33 (Tribal Employment Rights) of the Tribal Code/DFWP.
Overall Objectives of Position The Outpatient Coder/Billing Specialist is responsible for interpretation, analysis, and assignment of diagnostic and procedural codes. The Outpatient Coder/Billing Specialist promotes continuity of medical care, and ensures compliance with third party reimbursement policies, regulation, and accreditation guidelines. The Outpatient Coder/Billing Specialist performs a variety of tasks related to billing the professional fee for provider services including claim edit reviews and claim resolution. This job description is not an all-inclusive list of duties and responsibilities of this position. The Outpatient Coder/Billing Specialist is expected to perform all duties and responsibilities necessary to meet the goals and objectives of applicable programs. The Outpatient Coder/Billing Specialist is expected to live the Purpose and Values of the Poarch Band of Creek Indians and will go beyond the call of duty.
Primary Responsibilities of the Outpatient Coder/Billing Specialist
- Performs qualitative analysis of the medical record for documentation consistency and adequacy. Ensures that the final diagnosis accurately reflects the care and treatment rendered.
- Performs quantitative analysis of the medical record to assure all component parts, i.e., patient name, signatures, record number, and all reports indicated by the treatment are present.
- Makes final determination that medico-legal requirements of the record is complete, accurate, and reflects sufficient data to justify the diagnosis and warrant treatment and end results.
- Maintains record confidentiality in accordance with the Privacy Act and Tribal policy.
- Stays up-to-date with all CPT, ICD-10 and insurance company contract billing regulations.
- Reviews claim edit work queues and determines the corrective action necessary to resolve claims and completes accurate, timely and compliant billing.
- Posts insurance payments to the correct patient account.
- Makes adjustments to patient accounts according to the contractual arrangements.
- Reviews incorrect insurance payments.
- Responds to insurance company inquiries regarding claim questions and additional information requests.
- Checks claims for accuracy to billing and coding regulations.
- Researches and corrects claims that are pending payment.
- Resubmits claims as necessary.
- Submits claims to patient’s secondary insurance (including the primary carrier’s EOB) after receiving correct payment from primary carrier.
- Performs other duties as assigned by the appropriate person.
- Assigns and sequences a variety of codes including, but not limited to ICD/CPT/HCPCS codes based on the medical record analysis. Assures the final diagnoses and procedures as documented are valid and complete.
- Analyzes and abstracts information from the medical record to identify secondary complications and co-morbid conditions to assure appropriate assignment using the International Classification of Diseases (ICD) resources. Assures the procedure is related to the proper diagnosis when multiple diagnoses and procedures are listed.
- Analyzes provider documentation to assure the appropriate Evaluation and management (E&M) levels are assigned using the correct CPT/HCPC code.
- Assists patients and insurance companies with billing issues.
- Verifies and updates patient’s insurance information in the billing system for claims resolution.
- Utilizes insurance websites to check claims status, claims corrections, and appeals.
- Verifies accuracy of insurance payments received/posted.
- Verifies accuracy of adjustments.
- Works all denials with insurance companies.
- Works with various insurance companies via phone and online activities.
- Works closely with the Patient Registration department in coordinating demographic activities.
- Prioritizes work responsibilities and completes assignments in a timely manner.
- Works independently and collaboratively with the Health Department.
- Works as a team member to meet or exceed productivity and customer satisfaction goals.
- Complies with all Federal and State laws/regulations.
Education/License/Certification and Experience Requirements
- High School diploma or equivalent required.
- Must have five (5) years’ experience in a medical office setting (Registration, Referral, Scheduling, Coding, Billing, etc.).
- Must be certified for outpatient coding through the American Academy of Professional Coders or American Health Information Management Association.
- Experience with Medicare, Medicaid, and commercial insurance carriers required.
- Three (3) years of ICD-10 and CPT coding/clinical documentation experience required.
- Three (3) years of employment experience in outpatient healthcare billing required.
- Must have CRCR or CHAA certification or obtain CRCR or CHAA certification within one (1) year from date of hire.
- Demonstrated proficiency in coding and billing. Must successfully pass applicable knowledge, skills, and abilities exams.
- Absolute confidentiality and adherence to HIPAA regulations and the Privacy Act.
- Knowledge of medical terminology, abbreviations, techniques, and procedures; anatomy and physiology; major disease process; and pharmacology to identify specific clinical finds that support diagnoses.
- Knowledge, skills, and abilities in Health Information Management to analyze the medical record.
- Knowledge, skills, and abilities in operating computerized data entry and information processing systems.
- Skilled in data collection to compile and organize information for reporting and presentation.
- Adept at multi-tasking, have unquestionable integrity, with an uncompromising commitment to quality.
- Must be detail oriented and highly organized.
- Exceptional interpersonal and communication skills, both verbally and in writing.
- Must be people oriented and relate well to people from diverse backgrounds.
- Must possess a high level of maturity.
- Ability to sit for extended periods of time.
- Must meet CMS Covid Vaccination Requirement or be approved for a qualified medical or religious exemption prior to employment.
- Must successfully pass the required criminal and character background check.
- Must possess a valid state driver’s license and insurable driving record according to Tribal insurance guidelines.
- Ability to travel and participate in required training, leadership development, and other events.
- Ability to adequately and successfully perform all duties and responsibilities of this position.
Every applicant must complete an application provided by Human Resources. A resume will not be accepted in the place of an application.
**Please note ALL individuals selected for employment are required to complete a background investigation. Individuals being placed in positions designed as child-sensitive or data-sensitive must successfully complete a background check prior to employment.
INDIAN PREFERENCE, SPOUSAL PREFERENCE, OR FIRST GENERATION:
In the event more than one applicant meets the requirements, as stated in a job description, preference shall be given in the following order: (1) Tribal Member (2) First Generation Descendant of a Tribal Member (3) Spouse of Tribal Member (4) Indian (5) Non-Indian
In the event that a position of employment is funded in whole or in part my any federal grant and/or contract or other public funding, preference shall be given in the following order: (1) Indian (2) Non-Indian
In order to receive preference, the appropriate documentation must be submitted.
COMPLAINTS ABOUT RECRUITMENT PROCESS:
Complaints about the recruitment or selection process for employment should be directed in writing to the Human Resources Director of PCI Tribal Government.
An applicant who disagrees with any issue related to the application or hiring process may submit a letter to Human Resources within ten (10) calendar days from the date the applicant knew or should have known that an adverse hiring decision had been made.
Human Resources will provide a written response within fourteen (14) calendar days informing the applicant of any administrative remedy to be provided. The decision of the Human Resources Director shall be final and not subject to further administrative appeal. Any applicant who has exhausted all administrative remedies may be eligible to file a complaint with the TERO Office.
Jason B. Rackard
Human Resources Director
5811 Jack Springs Rd.
Atmore, AL 36502
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