Job Details

Medical Billing Specialist

Job Objective: A brief overview of the position. Reviews E&M and simple visit charges submitted by providers in assigned work queue(s) to validate Level of Service, place of service, new verses established, and modifier review to ensure valid creation of claim. Reviews and enters manual charges submitted by providers for external services. Reviews and resolves simple NCCI, LCD and MUE edits.

Reports to Billing Manager

Supervises None

Ages of Patients None

Blood Borne Pathogens Minimal/No Potential

Qualifications

Education Required: High School Diploma or GED

Preferred: Currently enrolled in a coding certification program or holding an Apprentice Certificate in coding- CPC or CCS

Preferred: General College Studies

Preferred: One year coding certificate or courses in Medical Terminology, Anatomy and Physiology and extensive training or experience in coding

Licensure/Certification Required: Within 18 months complete a coding certification program: CPC-A, CPC, CSC or RHIT

Experience Required: One to Three years of hands on billing/Charge Capture coding or related services

Essential Responsibilities

Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations.

Maintains quality of work based on current published standards.

Reviews documentation and sequences diagnoses and procedures using current coding guidelines for E&M and simple visit encounters.

Communicates with, certified coders department management and clinic staff to obtain needed documentation to ensure correct billing.

Completes assigned work queue assignment within departmental guidelines.

Maintains a thorough understanding of anatomy and physiology, medical terminology, disease processes through participation in continuing education programs to effectively apply ICD-10-CM and CPT-4 coding guidelines to inpatient and outpatient simple visit encounters.

Performs other duties as assigned.