Medical Coding & Billing Specialist

Unity Limited; De Pere (WI); Remote; USD 45,000 - 70,000; Full time

Job summary

An established industry player is seeking a detail-oriented Medical Coding & Billing Specialist to join their remote team. This role is essential in ensuring accurate coding and billing processes, facilitating optimal reimbursement for medical services. The ideal candidate will possess a strong background in medical coding, particularly with ICD-10, and demonstrate exceptional problem-solving and communication skills. This forward-thinking organization values its employees' growth and well-being, offering comprehensive health benefits, work-life balance, and opportunities for professional development. If you are passionate about making a meaningful impact in healthcare, this is the perfect opportunity for you.

Benefits

Comprehensive Health Benefits

Paid Time Off

403(b) Retirement Plan

Employee Assistance Program

Fitness Membership Reimbursement

Education Assistance

Leadership Development Programs

Qualifications

• 3+ years of experience in medical coding with CPC certification.
• Knowledgeable in CMS regulations and ICD-10 coding.

Responsibilities

• Review medical documentation and assign codes for reimbursement.
• Calculate and collect payments for medical services.
• Maintain patient records and handle billing inquiries.

Skills

Medical Coding

Billing

ICD-10 Coding

Attention to Detail

Communication Skills

Problem-Solving

Education

High School Diploma

Associate Degree

Certified Professional Coder (CPC)

Certified Coding Associate (CCA)

Tools

Electronic Medical Record (EMR) Epic

Microsoft Office (Excel & Word)

Job description

Description

Medical Coding & Billing Specialist - Remote

As the leader in end-of-life care, Unity is committed to attracting and retaining a diversified workforce consisting of motivated, engaged, and mission-driven staff members. We are dedicated to a culture reflective of our core values of Excellence, Collaboration, Integrity, Compassion, and Accountability. Working for Unity is a calling, and the people who answer are filled.

Minimum Qualifications & Certification/Licensure:

1. High School Diploma or GED required. Associate degree preferred.
2. Certified Professional Coder (CPC).
3. Certified Coding Associate (CCA) or higher certification for AHIMA
4. Minimum of 3 years of experience of coding with CPC.
5. Experienced in rules and regulations of CMS for both professional and facility settings.
6. Knowledgeable in ICD-10 coding

Essential Job Duties and Responsibilities:

The Medical Coding and Billing Specialist is responsible for reviewing medical documentation and ensuring that the correct diagnostic and procedural codes are assigned and sequenced properly to optimize reimbursement. The Medical Coding and Billing Specialist will calculate and collect payments for medical procedures and services. The Medical Coding and Billing Specialist performs complex clerical and accounting functions including updating patient data, verifying and processing invoice information, maintaining third-party billing records, billing patients when appropriate, developing payment plans, and resolving variances as needed. Follows up on submitted claims and patient billing; resubmits claims or corrects inaccuracies. May handle cash items and accounts receivable posting. They are a part of the Support Staff Team and help to support all aspects of the department. This is a remote working role.

• Determine patients’ benefits coverage and submit prior authorizations as needed.
• Document and notify clinical staff of any payer specific guidelines prior to patients being scheduled for services.
• Prepare and submit patient billing to include charges for hospice/supportive care management, clinician visits including physicians and APN’s, and skilled nursing home room and board.
• Maintain patient records and billing and adjusting, if needed, in accordance with Unity’s standards and Policies and Procedures.
• Complete entire billing process to include work ques.
• Resubmit claims to insurance companies, as necessary
• Perform research and analyze to facilitate resolution of provider/patient issues.
• Ensure timely handling of disputes, reversals, and appeals.
• Provide telephone support to facilities, insurance companies or patients for issues related to claims status, claims adjudication questions, and any basic questions regarding coverage status.
• Maintain an accurate aging report. Investigates unpaid balances in a timely manner. Follows up with the secondary/tertiary payers to obtain data crucial to claim payment and resubmissions and process adjustments. Research and resolve accounts as directed by management making appropriate decisions on accounts to be worked to maximize reimbursement.
• Handle all correspondence related to an insurance or patient account, contacting insurance carriers, patients, and other facilities as needed to get maximum payment on accounts and identify issues or changes to achieve client profitability.
• Performs complex clerical and accounting functions including billing patients, contacting patients regarding self-pay balances and collection of patient balances.
• Posts all incoming payments and adjustments in the Accounts Receivable ledger.
• Enter all Notice of Elections and Terminations/Revocations for Medicare and Medicaid.
• Examine and post Explanation of Benefits for accuracy.
• Follow up on missed payments and resolve financial discrepancies.
• Advise the Reimbursement Billing Supervisor of contractual allowance issues (allowable rate differences) or charge rate discrepancies specific to the payer group.
• Advise the Reimbursement Billing Supervisor of problem accounts that cannot be successfully resolved.
• Obtains, reads and reviews bulletins, newsletters and other periodicals to stay current on trends and changes in laws and regulations governing medical record coding and documentation.
• Provide guidance to providers and other staff in identifying and resolving issues or errors such as incomplete or missing records and documentation, ambiguous or nonspecific documentation and/or codes that do not conform to coding principles/guidelines.
• Back up of ICD-10 diagnosis coding for Health Claims and Coding Specialist
• Back up of ICD-10 diagnosis coding for Health Claims and Coding Specialist
• Participate in development of organization procedures and update of forms and manuals.
• Provide data and support to management as needed
• Other duties as assigned.

Knowledge, Skills, and Abilities:

• Highly motivated and organized with a strong attention to detail and analytical skills to help solve problems.
• Ability to communicate effectively, both verbally and in writing.
• Ability to maintain confidentiality and discretion in business relationships and exercise sound business judgment.
• Ability to prioritize and handle multiple tasks and capable of dealing with deadline pressures.
• Comply with all applicable local, state, and federal laws and regulations as well as policies and procedures of Unity.
• Perform other job-related duties as assigned.
• Knowledge of Medicare, Medicaid and Commercial insurance billing requirements.
• Knowledge of Electronic Medical Record (EMR) Epic. Knowledge of Microsoft Office: Excel & Word.
• Professional work ethic to include initiative and self-motivation.
• Ability to work independently and within a team environment.
• Outstanding problem-solving and organizational skills.
• Must have excellent phone, communication, and customer service skills.
• Must work well with constant interruptions, be able to multi-task and work well under pressure.
• Ability to collaborate across departments and build effective relationships with internal and external customers to achieve goals.

Why Unity? Unity is dedicated to supporting your well-being, growth, and success with a range of valuable benefits!

Health: We provide comprehensive health benefits, including medical, dental, and vision insurance, Health Savings Accounts, and flexible spending options for medical and dependent care. On-site health risk assessments and flu shots are also available to keep you and your family well.

Life: Unity values work-life balance, offering paid time off, extended illness and injury bank, bereavement leave, an Employee Assistance Program, and fitness membership reimbursement to support your personal needs and interests outside of work.

Security: For your financial peace of mind, Unity offers a 403(b) retirement savings plan, group life insurance, voluntary life insurance, as well as accident, critical illness, and disability insurance options.

Compensation: We reward your skills and commitment with competitive pay, overtime opportunities for hourly roles, and mileage reimbursement.

Career: Grow with Unity through internal and external learning opportunities, education assistance, and leadership development programs designed to support your professional journey.

All new employees are eligible for benefits on the first of the month following their date of hire.

For a full list of benefits: https://unityhospice.org/careers

Choose Unity as the place to grow your career, make a meaningful impact, and be valued every step of the way. Apply today to join a team that invests in you, both personally and professionally.

Requirements

1. High School Diploma or GED required. Associate degree preferred.
2. Certified Professional Coder (CPC).
3. Certified Coding Associate (CCA) or higher certification for AHIMA
4. Minimum of 3 years of experience of coding with CPC.
5. Experienced in rules and regulations of CMS for both professional and facility settings.
6. Knowledgeable in ICD-10 coding