(Hybrid working position)

Position Summary: The Medical Reimbursement Specialist is responsible for the accurate and timely submission of medical claims to insurance companies and other payors. The medical biller posts payments or adjudications as appropriate. Using knowledge of billing practices and standards including third party payor requirements, the medical biller will investigate denials to process appeals and collect payment. In addition, this position is responsible for reviewing coding for outpatient services for reimbursement and research compliance.

Supervision: Director of Health Information Management

** Medical Billing:**

• Performs claim review, verifies accuracy and completeness of all required information to perform submission to Medicare, Medicaid, commercial and private insurance payers
• Applies payments and adjustments to patient accounts.
• Review explanations of benefits for correct adjudication and payment according to applicable managed care contract terms and reimbursement.
• Review of unpaid claims, researching denials and/or lack of activity to ensure timely payment and maintain cash flow.
• Follow up with insurance payers for processing appeals and errors.
• Receive and resolve inquiries, concerns, or complaints related to patient accounts from patients, insurance carriers, employers, etc.
• Provide customer service and interact with clinicians, managers, and clients as needed to resolve outstanding items.
• Responsible for resolution and appropriate refunding of credit balances, denied claims, and charges on hold. Includes working credit balance reports as needed.
• Meet productivity and quality assurance benchmarks.

Coding:

• Identifies and assigns appropriate codes for the purpose of reimbursement, research, and compliance in accordance with ICD-10 and CPT coding guidelines.
• Accurately extracts clinical information from records according to established requirements using abstracting software.
• Interpret coding rules and general policies in addition to determining appropriate conclusions
• Complies with all federal, local and other legal requirements as they relate to medical coding practices.
• Observes confidentiality and safeguards all patient related information Communicates in a positive and professional manner with visitors, physicians, and staff.
• Must be able to explain codes, terminology and coding guidelines to physicians and hospital personnel.
• Maintains an optimal working relationship with peers, other departments, and physicians
• Attends continuing education classes to maintain coding proficiency in ICD-10-CM, CPT/HCPCS, and other areas as deemed necessary by management.
• Perform other job-related duties as required.

Job Skills:

• Excellent command of diagnostic and procedural classification systems with thorough understanding of the effect of data quality on prospective payment, utilization, and reimbursement.
• Current understanding of applicable coding guidelines, state and federal regulations, and managed care guidelines.
• Communicates effectively both verbally and in writing to convey and receive information.
• Knowledge of medical terminology and disease process
• Proficient knowledge of ICD, CPT/HCPCS coding systems
• Proficient in encoder technology and knowledge of third-party payer requirements
• Demonstrated skills working with Microsoft Excel and Office Suite products and EMR data eClinical EMR experience a plus)
• Possess strong written and verbal communications skills to communicate effectively with individuals at all levels of the organization
• Ability to adjust to changes in workflow
• Thoroughness and attention to detail
• Ability to work independently

Training and Education

Associate degree and/or Diploma in medical coding and billing or credentialed in medical coding and billing required.

Work Experience

• 5 or more years of experience in medical coding and billing
• CCA, CCS, CCS-P
• RHIT preferred
• Diploma in medical coding and billing or Credential in medical coding and billing required
• Customer Service Experience preferred

Employee Charge to NOVUS Mission:

Candidates should be aware of NOVUS Health strong commitment to diversity and inclusion. With a focus on providing trauma informed, holistic health we expect all staff to meet patients, community partners, and co-workers with respect and dignity. We challenge each other to acknowledge biases that exist in healthcare, including racial, gender, gender identity, sexual orientation, ethnicity, and/or personnel beliefs. We look for ways to eliminate these biases at all points of services and care. Together as a team member of NOVUS, we will begin to break down barriers, build access, and create healthier communities.