Medical Coding and Billing Specialist

SUMMARY

Sacred Heart Mercy Health Care Center is a Clinic dedicated to providing comprehensive medical care to those most in need in our area. The Clinic is an apostolate of the Religious Sisters of Mercy of Alma, MI, with the care provided flowing from the charism of Mercy. The Billing/Coding specialist is primarily responsible for the coding, dropping and resolution of claims to the various insurance companies and government agencies and for coordinating the clinic's assistance program for patients without insurance or in need of financial support. This position is also responsible for monitoring patient accounts, coordinating the patient assistance program and correspondence with insurance companies as needed.

ESSENTIAL FUNCTIONS:

1. Oversees the process of patient accounts, financial assistance and payment plans for patients.
2. Maintains appropriate adjustment plan for patient accounts under the direction of the Medical Administrator, to ensure access of care to patients without insurance or means to pay.
3. Review claim coding and submission of claims by Athena electronic medical record system or other coding and billing system as determined based on future needs. Evaluate accuracy and other options for coding and claim submission to best serve the needs of the Clinic. Maintain communication with vendor to adjust coding strategies as needed.
4. Assist providers in coding notes according to updates and best practice.
5. Reviews claims on hold and resubmit as necessary. Correspond with insurance companies as necessary to resolve claim issues.
6. Process direct insurance payments and explanation of benefits.
7. Communicate with patients to resolve concerns related to insurance billing and claim issues.
8. Cross-train to be able to cover front office functions and perform all other front office duties as assigned

REQUIRED EDUCATION AND EXPERIENCE:

1. High School Graduate or equivalent, additional education preferred
2. Completed course work specific to this position or equivalent experience
3. Certified Professional Coding certificate preferred

REQUIRED KNOWLEDGE, SKILLS, and ABILITIES:

1. Alignment with Clinic mission
2. Knowledge of coding and billing practices for the primary care environment including CPT, ICD-10 and HCPCS codes
3. Demonstrate professionalism while dealing with patients and other staff
4. Demonstrated proficiency using practice management systems (e.g., electronic medical records)
5. Knowledge of the current regulations regarding medical records maintenance and release

PHYSICAL DEMANDS:

1. Mobility and ability to sit, bend, reach and lift 25 lbs.
2. Sufficient near vision acuity to read information appearing on computer display screen, in hand-written forms, and printed on paper
3. Adequate hearing and verbal abilities to communicate effectively in person and by telephone

OTHER DUTIES: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Processes are continuing to evolve as we work to efficiently deliver quality care. Therefore duties, responsibilities, and activities may change at any time with or without notice.