Coding and Billing Specialist at Health Care Center for the Homeless – Orlando, Florida

Title: Coding and Billing Specialist

Reports to: Director of Operations

Status: Exempt

Work Schedule: Full Time

Position Summary: Under general supervision, reviews charges for patients.

Responsibilities & Expectations:

• Accounts for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications.
  Audits clinical documentation and coded data to validate documentation that supports diagnoses, procedures, and all services rendered for reimbursement and reporting purposes.
• Identifies diagnostic and procedural information and reviews physician pending charges for appropriate complexity using CPT coding guidelines.
  Analyzes medical records and identifies documentation deficiencies, the potential quality of care, and billing issues.
• Assigns codes for reimbursements and compliance with regulatory requirements utilizing guidelines and following up-to-date coding conventions.
• Works closely with leadership to research, analyze, recommend, and facilitate a plan of action to correct discrepancies and prevent future coding errors.
• Confirm patient demographic, insurance, and referring physician information is accurately entered in EPIC.
• Confirm insurance verifications and authorizations as applicable to claims.
  Enter all medical codes, CPT, HCPCS, and ICD-10 coding and modifiers in EPIC timely and accurate.
• Respond to audit findings and make applicable coding additions or corrections.
  Review Medicare Local Coverage Determinations (LCDs), Medicare bulletin updates, and Medicare NCCI.
• Identifies trends within discrepancies by location, physician, and specialty for training purposes
• Querying physicians/NPP to clarify a diagnosis or a procedure when the documentation is unclear. States questions according to proper protocol.
• Update EPIC’s patient’s account notes with any changes made to patient information or as otherwise dictated by company policy and procedure.
• Serves as a coding consultant to providers.
• Keeps abreast of compliance regulations, standards, and directives regarding governmental/regulatory agencies and third-party payers.
• Keeps abreast of standard coding guidelines (including Medicare, Medicaid, Managed Care, HEDIS, and FQHC guidelines).
• Ensures that clinical documentation substantiates the evaluation and management, procedure, and modifiers selected per federal, state, and medical group documentation and coding requirements, as well as Medicare guidelines and regulations.
• Manages significant workload and works efficiently under pressure to meet established deadlines with minimal supervision.
  Provides updates and status reports to management weekly.

CODING SPECIALTIES:

• Primary Care (+50% of charts/patients)
• Dental
• Behavioral Health
• Pediatrics Primary Care

Requirements:

• High School diploma. Associate or 4-year college degree preferred.
• Certified Professional Coder (CPC) through AAPC required.
• Three (3) years of related coding experience, preferably with an FQHC.
• Highly effective written and verbal communication skills.
• Knowledge of regulatory and policy compliance issues regarding medical coding/billing and documentation.
• Proficient in the industry’s requirements regarding Medicare, Medicaid, Managed Care Regulations, the International Classification of Diseases (ICD-10-CM/PCS), and the Current Procedural Terminology (CPT) coding systems.
• Must have proficient knowledge of ICD-10-CM, HCPCS, and CPT coding guidelines and clinical documentation knowledge
• Maintain quality and productivity standards established for the department and demonstrate proficiency in family practice, pediatrics, and behavioral health.
• Demonstrated good judgment.
• Experience Coding one or more of the following Primary Care (+60% of workload), Behavioral, Pediatrics, and Dental.
• Experience with electronic medical records (EMR) system with EPIC preferred.
• Knowledge of insurance companies coding policies and federal Medicare, FLORIDA Medicaid, and FQHC regulations.

Education: High School Diploma, GED, or equivalent experience. Associate’s degree preferred.

Certifications, Licenses, and Registrations:
CPC - Certified Professional Coder (AAPC) or similar AAPC credential. Will review AHIMA credentialed candidates pending their experience coding in a Pro Fee setting.

Physical Requirements:

There are no unique physical demands or vision requirements. The physical activities required are:

• Standing, sitting, walking, talking, and hearing. These activities are frequent, and as necessary, to be present and to communicate in performing essential and general duties.
• Reaching, bending, pushing or carrying, or lifting to 50 pounds. The activities are infrequent as necessary for the delivery of direct patient care or the use of equipment and supplies.

The work environment has no special physical or environmental conditions and is consistent with the level of patient care in our clinical healthcare setting. It also includes a business office setting. Exposure to outdoor weather conditions occurs infrequently when travel is necessary between facility sites.