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Billing & Coding Documentation Specialist

Description

JOB SUMMARY:

The Billing & Coding Documentation Specialist is responsible for billing and coding financial administration of operational duties and administration for team and finances processes. As the billing coordinator, there is a wide variety of general administrative duties necessary to conduct billing, bookkeeping and with the financial coordinator, regard to all financial and accounting activities, and any additional duties. Will serve as the primary coding and documentation specialist for billing invoices. Will audit coding and documentation for accuracy and appropriateness, serve as a coding and documentation educational resource for direct care staff and medical staff, and contribute to continuous improvement activities associated with clinical documentation. Will oversee all web-based applications regarding billing and coding. Directly reporting to the Billing and Coding Coordinator and the Accounts Receivables and Payable Analyst.

Bilingual a plus; Haitian Creole, Portuguese Creole, Spanish, Vietnamese, Chinese, or Cambodian

POSITION RESPONSIBILITIES AND TASKS:

  • Part of a team under the direction of the Billing & Coding Coordinator/practice manager, this position is responsible for ensuring optimal billing and collections revenue by ensuring patient accounts are thoroughly analyzed to ensure successful payment, and to ensure self-pay accounts are optimized for collections, reconciling copayment batches
  • Will analyze and report trends with Billing & Coding Manager and entries in QuickBooks on assigned patient accounts
  • Experience and knowledge of healthcare and medical terminology, including but not limited to: CPT, ICD9 /ICD10 codes and use of modifiers.
  • Maintains Revenue Cycle knowledge in the following areas including PFS, Customer Service, Cash Posting, Financial Assistance, Patient Access, HIM/Coding and/or 3rd party Reimbursement.
  • Maintaining all files and clinic billing documents invoicing, organize Data entry for Medical Billers
  • Enter data for direct care staff payroll related to billing documentation and Productivity Reports
  • Prepare and evaluate all periodical bills for account receivables to be submitted to third party vendors
  • Monitor all monthly activities and manage vendor invoicing and prepare appropriate financial reports
  • Maintain knowledge on all account information and monitor all invoices and statements
  • Monitor and collect data from various funders for billing accounts payable and account receivable
  • Prepare documentation invoices for patients and insurance billing, submit and process insurance claims
  • Coordinating Billing for all programs (Private Pay, Third Party Billing, MassHealth, State
  • Conducting prior authorization reviews obtains extensions to continue services
  • Enters all review results in appropriate data systems and excel sheet as Claims Reviewer
  • Claims status and resubmitted claims, Medical Collector to collect payments
  • Documenting all review findings in the designated review database
  • Creating correspondences and communications required by the contract, including denials
  • Creating reports reflecting the start and end date of services and keeping track of billing units used
  • Coordinate with medical billers, bookkeepers, Provide expertise in complete coding, documentation, acuity, risk adjustment and denials, Query providers for missing or unclear documentation, Conduct coding and documentation audits quarterly — analyze audit results to identify areas of opportunity Assist in implementation of solutions to optimize coding and documentation practices, Develop and maintain training materials including onboarding and ongoing education materials Conduct one-on-one and group educational/training sessions
  • Maintain confidentiality in all aspects of client, staff and agency information.
  • Maintain electronic and hard copy filing system
  • Maintain compliance with state and federal HIPPA

Maintenance & Quality Improvement:

  • Data entry in QuickBooks
  • Maintain daily billing for patient account payable and receivable
  • Ensures all patient data entry is Coded with appropriate diagnoses, CPT & HCPCS procedure codes
  • Provides staffing training on documentation for billing
  • Submitting billing claims and resubmitting claims research for payment
  • Maintain up to date compliance on billing and coding
  • Maintain tracking of patient authorizations units and billing tracking

KEY SKILLS & BEHAVIOR:

  • Strong interpersonal skills and excellent written, communication skills
  • Strong analytical skills and interpersonal skills willing to work directly with staff
  • Ability to communicate effectively within a variety of situations and diverse populations
  • Ability to work independently and as part of a team
  • High attention to detail

SALARY & BENEFITS:

  • $21-$26 per hour depending on experience
  • QSEHRA Health Reimbursement Plan ($400 per month allowance)
    • Eligible upon 90th day of full-time (32-40 hours a week) employment.
  • 401 K Plan 
  • Federal Holidays Paid
  • PTO – Accrual based, eligible upon hire; Able to use on 120th day of full-time (32-40 hours a week) employment
    • 2 Personal Days
    • 1 week (40 hours) of vacation
    • 5 Sick Days
  • Flexible Schedule
    • *Must however be willing to work some late afternoons and evenings until 8:15pm, and some weekends.
  • Education stipends with partnering colleges available after one year of employment.

TO APPLY: 

Via our website Job Board to view available positions and submit your application.

Screening questions will need to answered after you will be asked to complete assessment and send 

Resume, Cover letter, Three recommendations 

*Must be able to operate a motor vehicle and travel locally (as required by Plan)*

Location: Randolph (Southeast Region) and Braintree Massachusetts with satellite locations in various states, MA

Job Type: Full-time

Program: Administrative

Department: Financial Administration Offices

Age group:

Qualifications

QUALIFICATIONS REQUIRED AND EXPERIENCE:

BA or BS Degree preferred in Healthcare Administration, Accounting or Finance, experience with Accounting and/or Finance and Healthcare Administration experience, a minimum of 2 years of recent or previous Administrative support experience.  a minimum of 2 years of recent or previous Healthcare Administrative experience and one of the following Current Coding Certificate is required (CPC) Certified Professional Coder (CPBℱ) (CPC-H) Certified Professional Coder-Hospital Outpatient, Certified Professional Biller, (CPMA¼) Certified Professional Medical Auditor or (CPCOℱ) Certified Professional Compliance Officer or (CDEO¼) Certified Documentation Expert Outpatient.

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