JOB SUMMARY: The Billing and Coding Specialist is responsible for accurately assigning medical codes to eye care procedures, conducting chart audits to ensure compliance with coding guidelines, and processing insurance claims. This role involves analyzing medical records, identifying chargeable services, and working closely with healthcare providers to maximize reimbursement. Additionally, the specialist responds to insurance audit requests and assists with appeals and denials related to eye care claims.
EDUCATION AND EXPERIENCE:
1. High school diploma or equivalent required; associate or bachelor’s degree in healthcare administration, finance, or related field preferred.
2. Minimum of 3 years of experience in patient accounting, medical billing and insurance processing, preferably in an eye care or healthcare setting.
3. Certified Professional Coder certification or equivalent coding credential required. COT certification may be substituted.
ESSENTIAL SKILLS AND ABILITIES:
1. Knowledge of basic accounting principles and billing procedures in a healthcare environment.
2. Proficient knowledge of CPT, ICD-10, and HCPCS coding systems and guidelines, with specialized expertise in ophthalmology coding.
3. Strong analytical skills and attention to detail, with the ability to review and interpret complex medical records and documentation.
4. Excellent communication and interpersonal skills, with the ability to collaborate effectively with healthcare providers, insurance representatives, peers, clinic staff, and doctors.
Key Responsibilities:
1. Chart Audits and Coding:
o Conduct routine chart audits to review medical records and ensure accurate documentation of eye care services provided.
o Assign appropriate medical codes (CPT, ICD-10, HCPCS) to diagnoses, procedures, and services performed during eye exams, surgeries, and other treatments.
o Ensure compliance with coding guidelines, including documentation requirements for evaluation and management (E/M) services, diagnostic tests, and surgical procedures.
2. Compliance Training and Education:
o Develop and deliver training sessions on coding and documentation requirements, compliance regulations, and best practices for eye care providers and clinical staff.
o Stay current on changes to coding guidelines, regulatory requirements, and payer policies and disseminate relevant information to stakeholders.
o Provide ongoing support and guidance to healthcare providers and staff on coding-related queries and compliance issues.
3. Claim Processing and Submission:
o Compile and organize charge data from medical records to prepare accurate and complete insurance claims for submission.
o Verify patient demographics, insurance coverage, and authorization requirements prior to claim submission.
o Submit electronic claims to insurance carriers using billing software or clearinghouse platforms.
o Ensure kept and no charges and unbilled charges reports are run regularly to ensure all encounters are billed timely.
4. Insurance Audit Requests:
o Respond to insurance audit requests for medical records, coding documentation, and billing information related to eye care claims.
o Prepare and submit requested documentation in accordance with audit timelines and requirements.
o Collaborate with healthcare providers and clinical staff to gather additional information or clarification as needed.
5. Compliance Training and Education:
o Develop and deliver training sessions on coding and documentation requirements, compliance regulations, and best practices for eye care providers and clinical staff.
o Stay current on changes to coding guidelines, regulatory requirements, and payer policies and disseminate relevant information to stakeholders.
o Provide ongoing support and guidance to healthcare providers and staff on coding-related queries and compliance issues.
Job Type: Full-time
Pay: $19.00 - $24.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Disability insurance
- Employee assistance program
- Employee discount
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
- Work from home
Schedule:
Work setting:
- Ambulatory surgery center
- Hybrid work
Experience:
- ICD-10: 1 year (Required)
Ability to Commute:
- Tallahassee, FL 32308 (Required)
Ability to Relocate:
- Tallahassee, FL 32308: Relocate before starting work (Required)
Work Location: Hybrid remote in Tallahassee, FL 32308