1,048 Billing And Coding jobs in the United States

Job Description

Job Description

Job Title: Medical Billing & Coding Specialist

Company: Pinnacle Wound Management

Employment Type: Full-Time

Location: This is an on-site location in Gainesville, GA

About Us:

At Pinnacle Wound Management, we are dedicated to improving the lives of patients through high-quality wound care delivered by expert physicians, nurse practitioners, and physician assistants. As a growing leader in this specialized healthcare field, we’re looking for a detail-oriented and proactive Medical Billing & Coding Specialist to join our administrative team and ensure accurate, timely, and compliant billing operations.

Position Overview:

The Medical Billing and Coding Specialist will be responsible for reviewing clinical documentation, assigning appropriate diagnostic and procedural codes, and submitting claims to insurance companies. This role plays a vital part in our revenue cycle and overall patient experience.

Key Responsibilities:

• Review and accurately code medical procedures, diagnoses, and treatments using ICD-10, CPT, and HCPCS codes
  

• Prepare and submit clean claims to insurance companies both electronically and by paper
  

• Follow up on unpaid or rejected claims and resolve billing issues
  

• Ensure compliance with HIPAA and other federal regulations
  

• Collaborate with clinical staff to clarify documentation and improve coding accuracy
  

• Maintain up-to-date knowledge of billing regulations and payer guidelines
  

Qualifications:

• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent required
  

• 2+ years of medical billing and coding experience (specialty experience a plus)
  

• Strong knowledge of insurance guidelines, including Medicare and Medicaid
  

• Proficiency with electronic medical records (EMR) and billing software
  

• Excellent attention to detail and organizational skills
  

• Ability to handle confidential information with discretion
  

Why Join Us?

• Opportunity to be part of a mission-driven team making a direct impact on patient care.
  

• Supportive and collaborative work environment.
  

• Competitive salary and benefits package.
  

**Job Description**
**The Position**
We are seeking a highly skilled and experienced professional to join our team as the MedTech Billing & Coding Contract Specialist. This role is essential in developing and implementing strategies that support billing, coding, and reimbursement processes across diverse healthcare settings, including hospitals today and midwifery practices and birth centers in the future. The ideal candidate will possess deep expertise in facility and healthcare provider reimbursements by payer type, including commercial, Medicare, and Medicaid. The role will also support the development of a contracting strategy for the MedTech business.
**Responsibilities**
+ **Billing and Coding Acumen:** Develop and enhance billing and coding knowledge across different settings of care, ensuring accurate and efficient physician billing.
+ **Reimbursement Expertise:** Serve as an expert in facility and healthcare provider reimbursements by payer type, including commercial, Medicare, and Medicaid. Serve as an expert on DRG hospital and provider reimbursement.
+ **Customer Engagement:** Provide customer-facing support to troubleshoot billing, coding, and reimbursement challenges, ensuring high levels of satisfaction and resolution.
+ **Contract Strategy Development:** Lead the development of contracting strategies to optimize financial performance and compliance. Strong understanding of CMS rules, stark law, anti-kickbacks in medical device space. In addition, the role will support contract analytics and execution support efforts.
+ **Resource Development:** Create and maintain reimbursement resources to support internal teams and external partners.
+ **Payer Marketing:** Develop and implement marketing strategies to enhance payer relationships and reimbursement outcomes.
+ **Health Economics:** Develop health economics strategies and resources with focus on reduction in healthcare costs, revenue cycle management, cost avoidance, and cost consequence analysis.
+ **Systems Expertise:** proficiency in reimbursement and billing systems such as Epic and Cerner.
**Required Education, Experience and Skills**
+ Bachelor's degree in healthcare administration, business, or a related field (Master's preferred).
+ Professional certifications suggest certified professional coder (CPC, certified revenue cycle representative (CRCR), or certified healthcare financial professional (CHFP) preferred.
+ Extensive experience in billing, coding, and reimbursement processes.
+ In-depth knowledge of inpatient and maternal health settings.
+ Proven track record in strategy development and resource creation.
+ Strong background in payor access, contracting, value-based modeling, and contract analytics.
+ Experience in payer marketing and relationship management.
+ Leadership: Demonstrated ability to lead and inspire teams to achieve strategic goals.
+ Collaboration: Strong collaborative skills to work effectively with cross-functional teams and external partners.
+ Customer Engagement: Excellent customer engagement skills to address and resolve billing and reimbursement issues.
+ Analytics **:** Expertise in evaluating customer and contract performance data to identify and deliver recommendations to business leaders.
+ Minimum of five (5) years of experience in a similar role within the healthcare industry.
+ Strong analytical and problem-solving skills.
+ Excellent communication and interpersonal skills.
+ Ability to travel up to 25% of the time.
OGNPPH
**Who We Are:**
Organon delivers ingenious health solutions that enable people to live their best lives. We are a $6.5 billion global healthcare company focused on making a world of difference for women, their families and the communities they care for. We have an important portfolio and are growing it by investing in the unmet needs of Women's Health, expanding access to leading biosimilars and touching lives with a diverse and trusted portfolio of health solutions. Our Vision is clear: A better and healthier every day for every woman.
**US and PR Residents Only**
For more information about personal rights under Equal Employment Opportunity, visit:
EEOC Poster
EEOC GINA Supplement
OFCCP EEO Supplement
OFCCP Pay Transparency Rule
Organon is an Equal Opportunity Employer. We are committed to fostering a culture of inclusion, innovation, and belonging for all employees and job applicants. We ensure all employment practices are conducted without regard to race, color, religion, sex, sexual orientation, age, gender identity or gender expression, national origin, disability, veteran status, or any other characteristic protected by state or federal law.
**Search Firm Representatives Please Read Carefully**
Organon LLC., does not accept unsolicited assistance from search firms for employment opportunities. All CVs / resumes submitted by search firms to any employee at our company without a valid written search agreement in place for this position will be deemed the sole property of our company. No fee will be paid in the event a candidate is hired by our company as a result of an agency referral where no pre-existing agreement is in place. Where agency agreements are in place, introductions are position specific. Please, no phone calls or emails.
**Applicable to United States Positions Only:** Under various U.S. state laws, Organon is required to provide a reasonable estimate of the salary range for this job. Final salary determinations take a number of factors into account including, but not limited to, primary work location, relevant skills, education level, and/or prior work experience. The applicable salary range for this position in the U.S. is stated below. Benefits offered in the U.S. include a retirement savings plan, paid vacation and holiday time, paid caregiver/parental and medical leave, and health benefits including medical, prescription drug, dental, and vision coverage in accordance with the terms and conditions of the applicable plans.
**Annualized Salary Range (US)**
$03,100.00 - 175,300.00
**Please Note: Pay Ranges are Specific to local market and therefore vary from country to country**
**Employee Status:**
Regular
**Relocation:**
No relocation
**VISA Sponsorship:**
No
**Travel Requirements:** **Organon employees must be able to satisfy all applicable travel and credentialing requirements, including associated vaccination prerequisites.**
25%
**Flexible Work Arrangements:**
Not Specified
**Shift:**
Not Indicated
**Valid Driving License:**
Yes
**Hazardous Material(s):**
**Number of Openings:**
1
**Requisition ID:** R

**Billing and Coding Specialist**
**Description**
**University of Colorado Anschutz Medical Campus**
**Department: Neurosurgery**
**Job Title** **Billing and Coding Specialist**
**Position** **- Requisition #: 37575**
**Job Summary:**
**Key Responsibilities:**
**Education/Efficiency Development/Fiscal Monitoring - 35%**
+ Serve as the neurosurgery coding/billing liaison possessing high level knowledge and skills in neurosurgery billing/coding and EPIC to work with ECG consultants on the revenue cycle improvement plan.
+ Serve as the Departmental Coding/Billing Expert, helping clinical faculty to improve their revenue cycle through education and training.
+ Serve as the training expert for clinical faculty in coding/billing and best use of EPIC.
+ Determine what the key issues are, who are Champions already maximizing their billing and who needs the extra training and support.
+ Provide regular f/u through reports available in MyBi to clinical faculty to ensure they are on track with their productivity targets and maximizing their billing potential using all the tools.
+ Assist department clinical faculty with optimizing coding and charge capture procedures. Create efficiencies and reproducibility in the processes employed.
+ Prepare formalized reports and present results to department leadership, medical directors, clinical program directors, and clinicians.
+ Respond to inquiries from clinicians and administrative staff regarding billing, coding, and documentation.
+ Perform follow-up reviews after new provider training and provide additional education as needed.
+ Work closely with the DFA and Chair to analyze new services to generate an estimated profit/loss statement for any new service in collaboration with CU Medicine Client Services Manager assigned to Neurosurgery.
+ Collaborate on joint projects with internal clinical financial staff and CU Medicine departments to resolve billing and documentation issues.
**Compliance - 35%**
+ Perform review of medical records to ensure accurate assignment of diagnosis/HCC and procedure codes, requiring high level of knowledge of neurosurgery coding/billing and EPIC.
+ Perform coding compliance reviews as applicable to the specialty of Neurosurgery.
+ Review weekly charges processed reports for changes or deletions for Neurosurgery providers.
+ Review provider and billing data from MyBi reports.
+ Maintain current knowledge of coding guidelines, reimbursement guidelines, medications, and documentation requirements.
+ Attend CU Medicine meetings with Office of Value Based Performance, Revenue Cycle, Audit/Compliance, and other related meetings as a representative for the department of Neurosurgery
+ Maintain coding knowledge and billing regulations related to CPT, ICD-10, HCPCS, HCC and other CMS regulations.
**Continual Improvement Plan and Implementation - 30%**
+ Experience in developing QA/QI plans for coding/billing using EPIC, to provide expertise to develop this process.
+ Develop a QA/QI plan after working with ECG consultation to provide continual feedback and improvements to maximize earnings and ensure clinical faculty are always using tools and systems and have the knowledge to maximize their billing and productivity.
+ Follow up on open-ended issues and manage action plans.
+ Tracking, aggregating, and summarizing the changing coding and billing rules impacting Neurosurgery.
+ Work collaboratively with CU Medicine Applications for EHR system changes/updates to ensure accurate charge capture and sequencing.
**Work Location:**
Hybrid
**Why Join Us:**
**An Exciting Opportunity:**
**Why work for the University?**
+ Medical: Multiple plan options
+ Dental: Multiple plan options
+ Additional Insurance: Disability, Life, Vision
+ Retirement 401(a) Plan: Employer contributes 10% of your gross pay
+ Paid Time Off: Accruals over the year
+ Vacation Days: 22/year (maximum accrual 352 hours)
+ Sick Days: 15/year (unlimited maximum accrual)
+ Holiday Days: 10/year
+ Tuition Benefit: Employees have access to this benefit on all CU campuses
+ ECO Pass: Reduced rate RTD Bus and light rail service
**Equal Employment Opportunity Statement:**
**Qualifications:**
**Minimum Qualifications:**
+ Bachelor's degree in healthcare administration or a related field.
+ A combination of education and related professional experience may be substituted for the bachelor's degree on a year-for-year basis.
+ Three (3) years of clinical coding/auditing experience in Neurosurgery or a similar environment.
+ Active CCS-P, CPC, or RHIA/RHIT certification in conjunction with auditing credentials (e.g., CPMA).
+ Experience with commercial and government payers
+ Experience with third-party payer reimbursement, coding, and documentation requirements.
+ Experience with specific primary care medicine and/or sports medicine coding, ie CPT, HCC, ICD-10, HCPCS
+ Experience with EHR systems.
**Preferred Qualifications:**
+ 5+ years of clinical coding/auditing experience, preferably in Neurosurgery or a similar environment.
+ Experience in a teaching/academic medical environment.
+ Multi-specialty auditing experience.
+ Experience in professional fee and/or facility fee setting.
+ Experience with outpatient (HOPD, freestanding) and inpatient coding, risk adjustment auditing.
+ Experience building and implementing audit plans.
+ Experience with EHR systems (Epic preferred).
+ Experience with Centricity Business, and MyBI.
**Knowledge, Skills and Abilities:**
+ Ability to communicate effectively, both in writing and orally.
+ Ability to establish and maintain effective working relationships with a diverse group of employees and stakeholders at all levels throughout the institution.
+ Demonstrated commitment and leadership ability to advance diversity and inclusion.
+ Strong organizational, and time management skills.
+ Strong verbal, written, and presentation skills.
+ Strong project management skills and proficient in creating and maintaining detailed project plans.
+ Independent decision-making skills with the capacity for critical thinking and problem-solving.
+ Strong interpersonal skills and the ability to navigate complex relationships.
+ Ability to maintain confidentiality and demonstrate a high level of discretion in dealing with sensitive information.
+ Familiarity with Lean, Six Sigma, or other process improvement methodologies.
+ Proficiency with project management tools, spreadsheets (Excel), and communication platforms (e.g., Outlook, Microsoft Teams).
**How to Apply:**
**Screening of Applications Begins:**
**August 22. 2025**
**Anticipated Pay Range:**
**$70,000-$85,000**
**ADA Statement:**
**Background Check Statement:**
**Vaccination Statement:**
**Job Category**
**Primary Location**
**Schedule**
**Posting Date**
**Unposting Date**
**To apply, visit ( 2025 Jobelephant.com Inc. All rights reserved.
Posted by the FREE value-added recruitment advertising agency ( and Coding Specialist - 37575 University Staff
The Billing and Coding Specialist is responsible for ensuring accurate and compliant coding and billing practices for professional medical services within a neurosurgery clinical setting. This position will work in partnership with the CU Medicine departments (Audit, Compliance & Education (ACE) and Revenue Services Client Management) to focus on clinician documentation evaluation, review, and recommendations via education to maximize coding/documentation. They will also work closely with ECG who we will be contracting with via CU Medicine to assist with improvements to our Revenue Cycle. The Billing and Coding Specialist will operate within the Department of Neurosurgery mission area and will work collaboratively with various service centers within CU Medicine to optimize billing/collection processes for the department of Neurosurgery.
- this role is eligible for a hybrid schedule, 3 days in office and 2 days remote with occasional travel to meet with the clinicians at each of our HOPD practices, attend Program and APP meetings on a PRN basis, and attend the faculty meetings as requested.
At the University of Colorado's Department of Neurosurgery, we are committed to providing the highest level of quality care to our patients through innovation and collaboration, we strive to create, and share new knowledge, train future healthcare professionals, and seek to discover the latest innovations in the field of neurosurgery through our research endeavors.By joining us, you will be part of a dedicated team working to transform healthcare delivery and improve the lives of patients and communities. Our collaborative, supportive environment empowers staff to contribute to meaningful change and fosters professional growth. You'll have the opportunity to play a key role in advancing our strategic plan and creating lasting, positive impact within a mission-driven department. Together, we can shape the future of Neurosurgery.We have AMAZING benefits and offerexceptional amounts of holiday, vacation, and sick leave! The University of Colorado offers an excellent benefits package including:There are many additional perks & programs with the CU Advantage ( .
CU is an Equal Opportunity Employer and complies with all applicable federal, state, and local laws governing nondiscrimination in employment. We are committed to creating a workplace where all individuals are treated with respect and dignity, and we encourage individuals from all backgrounds to apply, including protected veterans and individuals with disabilities.
Applicants must meet minimum qualifications at the time of hire.
For full consideration, please submit the following document(s):1. A letter of interest describing relevant job experiences as they relate to listed job qualifications and interest in the position.2. Curriculum vitae / Resume3. Three to five professional references, including name, address, phone number (mobile number if appropriate), and email address.Questions should be directed to: Liz ( will be accepted until finalists are identified, but preference will be given to complete applications received by . Those who do not apply by this date may or may not be considered.
The starting salary range (or hiring range) for this position has been established as The above salary range (or hiring range) represents the University's good faith and reasonable estimate of the range of possible compensation at the time of posting. This position may be eligible for overtime compensation, depending on the level.Your total compensation goes beyond the number on your paycheck. The University of Colorado provides generous leave, health plans and retirement contributions that add to your bottom line.Total Compensation Calculator: ( University will provide reasonable accommodations to applicants with disabilities throughout the employment application process. To request an accommodation pursuant to the Americans with Disabilities Act, please contact the Human Resources ADA Coordinator at ( .
The University of Colorado Anschutz Medical Campus is dedicated to ensuring a safe and secure environment for our faculty, staff, students, and visitors. To assist in achieving that goal, we conduct background investigations for all prospective employees.
CU Anschutz strongly encourages vaccination against the COVID-19 virus and other vaccine preventable diseases ( . If you work, visit, or volunteer in healthcare facilities or clinics operated by our affiliated hospital or clinical partners or by CU Anschutz, you will be required to comply with the vaccination and medical surveillance policies of the facilities or clinics where you work, visit, or volunteer, respectively. In addition, if you work in certain research areas or perform certain safety sensitive job duties, you must enroll in the occupational health medical surveillance program ( . Application Materials Required: Cover Letter, Resume/CV, List of References : Finance and Accounting : Hybrid Department: U0001 -- Anschutz Med Campus or Denver - 20335 - SOM-NS GENERAL OPERATIONS : Full-time : Aug 19, 2025 : Ongoing Posting Contact Name: Liz Seelenfreund Posting Contact Email: ( Position Number: jeid-a004b7c6713c784ca528b24badf8c340
The University of Colorado does not discriminate on the basis of race, color, national origin, sex, age, pregnancy, disability, creed, religion, sexual orientation, gender identity, gender expression, veteran status, political affiliation, or political philosophy. All qualified individuals are encouraged to apply.

Full job description: Medical Billing and Coding Specialist

CPC certification (preferred)

Experienced (at least one year)

Healthcare

Two-year degree

Duties

Handling insurance claims accurately and efficiently.Determining which codes end up on a patient’s bill for third-party billing purposes.Properly coding services, procedures, diagnoses, and treatments.Preparing and sending invoices or claims for payment.Correcting rejected claims.Tracking payments.Reviewing clinical documentation to extract and translate billable information into medical codes.

This Company Describes Its Culture as:

Detail-oriented -- quality and precision-focusedPeople-oriented -- supportive and fairness-focusedTeam-oriented -- cooperative and collaborative

Schedule:

Monday to FridayDay shift

Job Type: Full-time

Benefits:

401(k)Dental insuranceHealth insuranceLife insurancePaid time offVision insurance

Experience:

healthcare billing: 1 year (Required)Billing: 1 year (Required)

Education:

Associate (Preferred)

Work Location: In person

Benefits

Pulled from the full job description

·    401(k)

·    Dental insurance

·    Health insurance

·    Life insurance

·    Paid time off

·    Vision insurance

Requirements

Duties

Handling insurance claims accurately and efficiently.Determining which codes end up on a patient’s bill for third-party billing purposes.Properly coding services, procedures, diagnoses, and treatments.Preparing and sending invoices or claims for payment.Correcting rejected claims.Tracking payments.Reviewing clinical documentation to extract and translate billable information into medical codes.Benefits

Benefits

Pulled from the full job description

·    401(k)

·    Dental insurance

·    Health insurance

·    Life insurance

·    Paid time off

·    Vision insurance

Join the Cleveland Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare. Cleveland Clinic is recognized as one of the top hospitals in the nation. At Cleveland Clinic, you will work alongside passionate and dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world.
As a Corporate Compliance Coding/Billing Specialist, you will support the Office of Corporate Compliance by maintaining and administering the Cleveland Clinic Health System (CCHS) Compliance Program. In this role, you will conduct billing and coding compliance reviews, monitor regulatory guidelines, and address coding-related concerns. A caregiver in this role is also responsible for investigating billing and coding compliance issues, ensuring adherence to federal and state regulations, and identifying revenue cycle compliance risks-such as potential False Claims Act exposures-to protect the organization.
This role offers professional development opportunities, including coding and compliance education, direct collaboration with department leadership, and cross-functional experience working with caregivers in other focused areas of compliance.
**A caregiver in this position works remotely out of Florida, Ohio, or Nevada, Monday-Friday 8:00am - 5:00pm, with occasional onsite requirements in Cleveland, OH.**
A caregiver who excels in this role will:
+ Integrate system-wide compliance initiatives and participate in the resolution of issues through the creation of corrective action plans.
+ Assist the Director with identifying and analyzing areas of risk.
+ Coordinate responses to monitoring and audit activities.
+ Distribute material from resources with relevant compliance-related information, including DHHS, CMMS, OCR and OIG.
Minimum qualifications for the ideal future caregiver include:
+ Bachelor's degree and three years of recent experience with healthcare compliance, auditing, billing, coding, privacy, research, regulatory review and application, reimbursement and/or information management.
+ The following may substitute the education and experience requirement: high school diploma/GED and five years of relevant experience, associate's degree and four years of relevant experience, RN and three years of relevant experience, or JD and one year of relevant experience.
+ Unbiased approach to situations combined with a non-judgmental attitude.
+ Can identify and address multiple perspectives on issues.
+ Can lead investigations into root-cause identification and subsequent process improvement initiatives.
+ Can manage, coordinate and track multiple cases/projects simultaneously and appropriately prioritize tasks.
+ Proficiency in using standard software applications (Word, Excel, PowerPoint, etc.).
Preferred qualifications for the ideal future caregiver include:
+ Three years of HIM coding/billing experience
+ One of the following certifications: CPC, CCS-P, RHIT, CCA, AHIMA, COC, AAPC
+ Certification in healthcare compliance preferred
+ Knowledge of healthcare and/or state and federal statutes and regulations governing hospitals and or the healthcare industry.
Our caregivers continue to create the best outcomes for our patients across each of our facilities. Click the link and see how we're dedicated to providing what matters most to you: Requirements:**
+ Work typically performed in an office setting with frequent use of computers and telephones.
+ Includes walking and driving of varying distances on campus and at off-site locations.
+ Ability to communicate and exchange accurate information.
+ Ability to perform work in a stationary position for extended periods.
+ Ability to work with physical records or operate a computer or other office equipment.
+ In some locations, ability to travel throughout the hospital system.
+ In some locations the ability to move up to 25 lbs.
**Personal Protective Equipment:**
+ Follow standard precautions using personal protective equipment as required.
**Pay Range**
Minimum hourly: $33.46
Maximum hourly: $51.03
The pay range displayed on this job posting reflects the anticipated range for new hires. While the pay range is displayed as an hourly rate, Cleveland Clinic recruiters will clarify whether the compensation is hourly or salary. A successful candidate's actual compensation will be determined after taking factors into consideration such as the candidate's work history, experience, skill set, and education. This is not inclusive of the value of Cleveland Clinic's benefits package, which includes among other benefits, healthcare/dental/vision and retirement.
Cleveland Clinic Health System is pleased to be an equal employment employer: Women / Minorities / Veterans / Individuals with Disabilities

**Job Type:** Regular
**Time Type:** Full time
**Work Shift:** Day (United States of America)
**FLSA Status:** Non-Exempt
**When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives.**
Identifies, reviews, and interprets third party payments, adjustments and coding denials for all professional services. Reviews provider documentation in order to determine appropriate coding and initiate corrected claims and appeals. Duties include hands on coding, documentation review and other coding needs for ICD-9, ICD-10. Works directly with the Billing Supervisor and Coding Manager to resolve complex issues and denials through independent research and assigned projects.
**Job Description:**
**Essential Duties & Responsibilities** including but not limited to:
**Coding Responsibilities:**
1. Provides review and/or coding of any coding related denied professional services for appropriate use of CPT, ICD-9, ICD-10, HCPCS, Modifier usage/linkage.
2. Periodic review of codes, at least annually or as introduced or required.
3. Reviews and analyzes rejected claims and patient inquiries of professional services, and recommends appropriate coding corrections via paper or electronic submission to the Follow up Team.
4. Reports coding trends and issues to the coding supervisor for education within the coding department and/or physician education.
5. Confers regularly with the Coding Department through regular departmental staff meetings, on-on-one meetings to review and discuss coding denials and education.
6. Maintains certification requirements for coding.
**Follow Up Responsibilities:**
1. Monitors days in A/R and ensures that they are maintained at the levels expected by management. Analyzes work queues and other system reports and identifies denial/non-payment trends and reports them to the Billing Supervisor.
2. Responds to incoming insurance/office calls with professionalism and helps to resolve callers' issues, retrieving critical information that impacts the resolution of current or potential future claims.
3. Establishes relationships and maintains open communication with third party payor representatives in order to resolve claims issues.
4. Reviews claim forms for the accuracy of procedures, diagnoses, demographic and insurance information, as well as all other fields on the CMS 1500.
5. Reviews and corrects all claims/charge denials and edits that are communicated via Epic, Explanation of Benefits (EOB), direct correspondence from the insurance carrier or others and uses information learned to educate PFS and office staff to reduce future denials and edits of the same nature. Initiates claim rebilling or corrections and obtains and submits information necessary to ensure account resolution/payments.
6. Identifies invalid account information (i.e.: coverage, demographics, etc.) and resolves issues.
7. Evaluates delinquent third party accounts and processes based on established protocols for review, payment plan or write-off.
8. Reviews/updates all accounts for write-offs and refunds.
9. Keeps informed of all federal, state, and managed care contract regulations, maintains working knowledge of billing mechanics in order to properly ascertain patients' portion due.
10. Completes all assignments per the turnaround standards. Reports unfinished assignments to the Billing Supervisor.
11. Handles incoming department mail as assigned.
12. Attends meetings and serves on committees as requested.
13. Maintains appropriate audit results or achieves exemplary audit results. Meet productivity standards or consistently exceeds productivity standards.
14. Provides and promotes ideas geared toward process improvements within the Central Billing Office.
15. Assists the Billing Supervisor with the resolution of complex claims issues, denials and appeals.
16. Completes projects and research as assigned.
17. Provides feedback and participates as the coding representative for the Patient Financial Services Department on the Revenue Cycle teams.
**Secondary Functions:**
1. Enhances professional growth and development through in-service meetings, education programs, conferences, etc.
2. Complies with policies and procedures as they relate to the job. Ensures confidentiality of patient, budget, legal and company matters.
3. Exercises care in the operation and use of equipment and reference materials. Performs routine cleaning and preventive maintenance to ensure continued functioning of equipment. Maintains work area in a clean and organized manner.
4. Refers complex or sensitive issues to the attention of the Billing Supervisor to ensure corrective measures are taken in a timely fashion.
5. Observes irregularities in the cash/denial posting process and reports them immediately to the Billing Supervisor.
6. Accepts and learns new tasks as required and demonstrates a willingness to work where needed.
7. Assists other staff as required in the completion of daily tasks or special projects to support the department's efficiency.
8. Performs similar or related duties as assigned or directed.
**Education & Professional Development:**
1. Researches and stays updated and current on CMS (HCFA), AMA and Local Coverage Determinations (LCD's), or Local Medical Review Policies (LMRP's) to ensure compliance with coding guidelines.
2. Stays current on quarterly CCI Edits, bi-monthly Medicare Bulletins, Medicare's yearly fee schedule, Medicare Website, and specialty newsletters.
3. Makes guidelines available via, paper, on-line access, web access, or any other means provided by manager.
**Organizational Requirements:**
1. Maintain strict adherence to the Lahey Health Confidentiality policy.
2. Incorporate Lahey Health Standards of Behavior and Guiding Principles into daily activities.
3. Comply with all Lahey Health Policies.
4. Comply with behavioral expectations of the department and Lahey Health.
5. Maintain courteous and effective interactions with colleagues and patients.
6. Demonstrate an understanding of the job description, performance expectations, and competency assessment.
7. Demonstrate a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.
8. Participate in departmental and/or interdepartmental quality improvement activities.
9. Participate in and successfully completes Mandatory Education.
10. Perform all other duties as needed or directed to meet the needs of the department.
**Minimum Qualifications:**
Education: High School diploma or equivalent, plus additional specialized training associated attainment of a recognized Coding Certificate
Licensure, Certification & Registration: CP (Certified Professional Coder through AAPC), CPC-A (Certified Professional Coder - Apprentice through AAPC), or CCS-P (Certified Coding Specialist Physician Based through AHIMA)
Experience: 1-2 years of experience in billing, coding, denial management environment related field.
Skills, Knowledge & Abilities:
+ Ability to work independently and take initiative
+ Good judgment and problem solving skills
+ Excellent organizational skills
+ Ability to interact and collaborate effectively and tactfully with staff, peers and management.
+ Ability to promote team work through support and communication.
+ Ability to accept constructive feedback and initiate appropriate actions to correct situations.
+ Ability to work with frequent interruptions and respond appropriately to unexpected situations.
**As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment.**
**More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.**
**Equal Opportunity** **Employer/Veterans/Disabled**