JOB TITLE: Billing/Coding Specialist DEPT.: Billing

CLASSIFICATION: Full Time FLSA STATUS: Non-Exempt

SUPERVISOR: Business Office Manager EFFECTIVE DATE: 4/2024

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Location: Panorama Pediatric Group – 220 Linden Oaks, Suite 200, Rochester NY 14625

About Us: Panorama Pediatric Group is a highly reputable medical practice comprising of 9 physicians and 7 Advanced Practice Providers (APPs). We specialize in primary care for newborns to adolescents and are dedicated to providing exceptional patient care.

Job Description:

We are seeking an experienced and detail-oriented Billing & Coding Specialist to join our team at our bustling practice. The ideal candidate will have a strong background in medical billing and coding, along with excellent organizational and communication skills.

Essential Job Functions/Responsibilities:

Coding/Auditing:

· Evaluates medical record documentation and encounter coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflect and support the outpatient visit, and to ensure that data comply with legal standards and guidelines.

· Interprets medical information such as diseases or symptoms, and diagnostic descriptions and procedures for a given visit in order to accurately assign and sequence the correct ICD 10, CPT codes and HCPCS II.

· Reviews Medicaid, Medicaid Managed Care, and Commercial reimbursement claims before submission for completeness and accuracy and to minimize claim denial.

· Provides technical guidance to clinical providers and other departmental staff in identifying and resolving issues or errors, such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, or codes that do not conform to approved coding principles/guidelines.

· Educates and advises staff on proper code selection, documentation, procedures, and requirements.

· Identifies training needs, prepares training materials, and conducts training for clinical providers and support staff to improve skills in the collection and coding of quality health data.

· Measure and report trends in provider coding

Billing Process:

· Responsible for gathering/entering charge information, coding, database information and distributing appropriate information, including submitting claims to all insurance companies.

· Submit third party claims to payers for processing

· Evaluate encounters for completeness and ability to be billed.

· Responsible for problem solving denials and rejections from insurance companies and clearing houses.

· Responsible for researching outstanding claims for insurance companies and taking the appropriate action needed to expedite processing of claims.

· Resubmit denied claims as necessary

· Responsible for researching overpayments and taking appropriate action needed to resolve the overpayment per NYS Unclaimed Funds guidelines.

· Responsible for working all patient and client accounts to industry-specific applications to include invoice creation, billing and posting receivables, receipts log, daily edits, prepare deposits, and reconciliations per PPG standards.

· Contact patients to resolve billing problem

· Aggressively follow-up on collection of aged accounts receivable

· Interact with Case Management staff on insurance problems

· Compliance activities as directed

Payment Processing:

· Post third party remittances

· Post payments received on patient and client accounts in a timely manner.

· Work denials and rejections from payers

· Reconcile industry-specific applications to general ledger and resolve differences in a timely manner

Credentialing:

· Maintain Provider insurance panels and credentialing

· Assure all payer contracts are up to date and maintained

Cash Receipts:

· Post cash receipts (electronic and manual) to the general ledger in a timely manner.

· Reconcile cash receipts received (the daily edit) to the EMR ledger (daysheet posting)

Miscellaneous:

· Provide support within the Finance dept. in the event of another staff member’s absence.

· Ensure patient demographics and insurance information is accurately entered in the EMR system.

· Requires the ability to relate to people of diverse backgrounds, cultures, races, sexual orientations and gender identities or expressions.

· Responsible for maintaining confidentiality of all patient, proprietary and protected information.

· Miscellaneous filing, copying, faxing, etc. as needed to support Finance staff.

· Employees are accountable for meeting performance standards of their departments. They participate in compliance audits and quality improvement plans.

· Other job duties as assigned by supervisor.

Essential Competencies:

· Carry out these duties in a responsible professional and ethical manner, upholding the mission and values of the Practice

· Participate in departmental and Practice-wide staff meetings and other training in-service as assigned.

· Demonstrate awareness of Practice mission, organizational goals, values, policies, and procedures; work effectively across departmental boundaries, represent the Practice in professional manner

· Requires the ability to relate to people of diverse backgrounds, cultures, races, sexual orientations and gender identities or expressions.

Skills and Abilities:

· Skill in computer programs, spreadsheets, and applications.

· Analytical and problem-solving skills.

· Skill of persistence is needed when necessary.

· Ability to examine documents for accuracy and completeness.

· Ability to read, understand and follow oral and written instruction.

· Ability to communicate effectively and work with others.

· Knowledge of office billing practices, policies, and procedures.

· Knowledge of coding policies.

· Knowledge of medical terminology, ICD 10-CM and CPT coding.

· Knowledge of the insurance industry.

· Knowledge and ability to use proper English, grammar, spelling, and punctuation.

· Ability to handle multiple projects and duties simultaneously while maintaining high levels of confidentiality and strict adherence to deadlines.

· Ability to work with many interruptions.

· Ability to analyze, interpret and draw inferences from research findings.

· Excellent organizational skills and attention to detail.

· Excellent verbal and written communication skills.

· Excellent customer service skills and knowledge (both over the phone and in person).

· Excellent computer skills – Word, Excel, Outlook, EMR.

· Excellent problem-solving abilities.

· Ability to make administrative/procedural decisions and judgments.

· Ability to problem solve and use critical thinking skills.

· Ability to work independently.

Education and Experience:

· One year experience in a medical office setting required. Experience with Medent and EMR preferred.

Physical Requirements:

· Sedentary work, ability to sit for extended periods of time.

· Manual dexterity for using an adding machine/calculator and computer keyboard.

· Required to stand, sit, walk, use hands to finger, handle or feel; reach with hands and arms, talk and hear.

· Occasionally, the employee must stoop, bend and lift or move up to 25 lbs.

· Specific vision abilities required include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus.

· Ability to read data on the computer monitor and written documents.

· Extensive use of computer software, typing and concentration.