Medical Billing Specialist/Coder, Business Office, Downtown Nashville

SUMMARY: The Charge Entry Specialist captures and reviews all billing codes prior to electronic claims filing, for accuracy and adherence to payer specific coding guidelines, for a multi-specialty physician group practice.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Reviews daily charges from the electronic health record to ensure coding and billing guidelines are followed
• Utilizes CPT, ICD-10CM, and HCPCS coding and modifier usage during daily reviews
• Utilizes various coding and billing references to resolve complex billing scenarios
• Ensures progress notes are coded accurately and to the highest level of specificity
• Maintains strong knowledge of payer billing guidelines and policies
• Researches front-end claim rejections and works cooperatively with appropriate staff to resolve discrepancies
• Timely alert any identified issues and/or risk that may require further research
• Fulfill month end requirements ensuring all charges capture
• Ability to meet deadlines and prioritize responsibilities

Secondary Responsibilities:

• Maintains strong knowledge of both local and national CMS policies, as well as various private-payer coding and billing guidelines.
• Utilizes the Correct Coding Initiative Edit List (CCI) when billing for multiple services during the same encounter and understands how to correctly apply Modifiers.
• Informs Patient Accounts Department when additional account balance reviews are needed.
• Researches front-end claim rejections and works cooperatively with appropriate staff to resolve discrepancies.
• Utilizes various coding and billing references to resolve complex billing scenarios.
• Consistently follows internal coding and billing protocols and policies.
• Demonstrates a commitment to expand coding & billing knowledge by participating in various continuing education opportunities each year.
• Demonstrates a positive willingness to take on additional assignments and responsibilities.
• Must maintain professional and courteous relationships with all team members at all times. 
• Must have predictable and consistent attendance and follow all attendance policies.

Skills/Qualifications: 

Active Certified Coder License CPD, CCS). Required experience in OB/GYN.  Epic experience is desirable.

 SUPERVISORY RESPONSIBILITIES

• None

Qualifications

CERTIFICATES, LICENSES, AND REGISTRATIONS

• Active Certified Coder License preferred (CPC, CCS)  

   

  EDUCATION and/or EXPERIENCE

• High school diploma required
• OB/GYN Coding Experience Preferred
• 5+ years of Charge Entry or Medical Billing experience required
• Multi-Specialty physician coding experience preferred
• Completion of an accredited Medical Coding/Billing Program preferred
• Must have knowledge of CPT and ICD10
• Experience with EPIC EMR System and Electronic Charge Capture preferred

   

  KNOWLEDGE, SKILLS, AND ABILITIES

• Advanced knowledge of CPT, ICD-10CM, HCPCS coding and of Modifier usage for multiple specialties
• Knowledge of CMS billing and documentation guidelines and CCI Edit Lists
• Advanced understanding of medical documentation requirements for E/M coding and office procedures
• Ability to abstract key information from the medical record to ensure accurate coding

• Effective communication skills, to explain guidelines to new employees in an easy to understand manner
• Excellent computer skills, including advanced typing speed, ten-key and mouse click selection skills
• Ability to easily and quickly maneuver through various computer software programs such as MS Outlook, Word, Excel, electronic health records, patient billing systems, and other medical information software systems
• Exceptional attention to detail and the ability to quickly identify discrepancies or uncommon billing situations

• Strong judgment skills and ability to work through complex matters independently
• Excellent time management and organizational skills
• Ability to prioritize work responsibilities and complete assignments in a timely fashion
• Strong initiative to anticipate departmental needs and work supportively to respond to such needs.
• Ability to work effectively and cooperatively with all levels of management, physicians, team colleagues, and other departments.

   

  PHYSICAL DEMANDS

• Must be able to sit for long periods of time
• Requires moderate walking, bending, pushing, pulling, twisting and lifting
• Mental alertness

  WORK ENVIRONMENT

• High volume, faced paced office environment with a strong commitment to timeliness and organization
• Office environment-limited exposure to communicable diseases.
• No exposure to blood-borne pathogens or contaminated body fluids