Coding Specialist Biller 2 (WA)_Revenue Cycle Operations

Planned Parenthood Great Northwest, Hawai'i, Alaska, Indiana, Kentucky; Idaho; On-site; USD 37,000 - 54,000; Full time

Job summary

Planned Parenthood Great Northwest, Hawai'i, Alaska, Indiana, Kentucky is seeking a Coding Specialist/Biller 2 to ensure compliant medical documentation, coding, and billing under supervision. You will improve front-end revenue cycle procedures, handle coding reviews, queries, denials, and payments.

Requires CPC, Associate degree preferred, at least two years in medical billing; Epic experience a plus. Seattle, WA based, full-time, non-exempt; benefits include medical, dental, vision and

Qualifications

• Minimum two years in medical billing operations.
• Experience with electronic practice management systems.
• Experience with health center management desirable.
• Front-end revenue cycle experience required.

Responsibilities

• Perform prospective and retrospective coding reviews to ensure accuracy.
• Submit and manage provider coding queries for documentation needs.
• Work queues to verify claim accuracy and timely filing.
• Review rejections and denials to resolve claims.
• Support coding audits and provide medical records for billing requests.
• Monitor help desk tickets and coordinate with Patient Accounts.

Skills

Payer contracts

CPT-4/ICD-10

Billing compliance

Confidentiality

Education

Associate degree in finance or accounting

Tools

Epic EHR

Job description

About this position:

Under the supervision and direction of the Director, Manager, or Supervisor, the Coding Specialist/Biller 2 ensures compliance in medical documentation, coding, and billing. This role performs the duties of the Biller 2, with time set aside for coding and documentation activities.

What you’ll be doing:

You will ensure that coding and billing comply with applicable rules and regulations. You will work with staff to improve the front-end revenue cycle procedures carried out in our Health Centers, and you will support coding and revenue cycle activities.

Key Responsibilities:

• Perform prospective and retrospective coding reviews to ensure claims are accurate, and make needed corrections for payer reconsideration
• Submit and manage provider coding queries for cases that need additional documentation or a provider response
• Work assigned work queues to verify claim accuracy, take corrective action, and ensure timely filing
• Write off balances when appropriate, up to the approval level authorized for a Coding Specialist/Biller
• Review all rejections and denials, including coding and documentation issues, and take action to resolve claims
• Identify trends in rejections and denials and report findings to the Coding Integrity Manager for follow-up
• Ensure quality, compliance, and continuous improvement in coding, documentation, and billing
• Accurately bill third-party payers to maximize reimbursement, following all department procedures and processes
• Check proof of eligibility according to organizational and third-party protocols
• Respond to inquiries from patients, health center staff, and insurance companies in line with affiliate customer service standards
• Provide pre-verification services to health centers and patients as requested
• Monitor help desk tickets, refer patient callback tickets to a Patient Account Representative when appropriate, and work other tickets to prompt resolution
• Ensure bills are processed on time by managing work queues and correcting electronic bill submissions
• Follow up on all incorrect, denied, and unpaid claims, and reconcile third-party accounting information
• Support internal and external coding audits
• Provide medical records for billing-related requests, including claim reimbursement, payer audit, and risk adjustment requests

Education:

• Associate degree in finance, accounting, or a related field preferred

Certifications:

• Certified Professional Coder (CPC) certification required

Experience:

• Minimum of two years of experience in a medical billing operation required
• Demonstrated experience with electronic practice management and health record systems (Epic a plus)
• Experience with health center management highly desirable
• Comprehensive, in-depth experience with the front-end revenue cycle

Skills:

• Thorough understanding of third-party payer contracts, Medicaid reimbursement, and compliance
• Proficiency and advanced working knowledge of CPT-4 and ICD-10 coding requirements
• Advanced knowledge of third-party billing and OIG billing compliance guidelines
• Ability to maintain confidentiality of all PPGNHAIK business and activities, on and off the job

Salary Range:

WA: $26.65 – $38.93 per hour

*Actual starting pay will be determined based on factors including, but not limited to, relevant experience, education, internal equity, geographic location, and the budgeted hiring range established for the position.

Location:

2001 East Madison Street;
Seattle, WA 98122

Position Type:

Full-time – Non-exempt

Benefits Eligibility:

This position is eligible for PPGNHAIK benefits. As part of our total compensation, we provide a comprehensive benefits plan including medical, dental and vision plans, retirement, paid time off, short and long-term disability, and life insurance. For more information about our benefits program, please email [e-mail].

Other Information:

All our employees must present proof of receiving a current flu shot prior to their first day of employment.

What we expect from you:

• That you adhere to our code of conduct, policies, procedures, and protocols.
• That you always demonstrate a high degree of professionalism.
• That you always support and model our customer service standards.
• That you value continuous learning and seek ongoing training and development.