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Patient Accounts Coding Specialist & Biller

Patient Accounts Coding Specialist & Biller

New England Life CareCanton, MA, US
12 days ago
Job type
  • Full-time
Job description

Job Description

Job Description

New England Life Care (NELC) is one of the fastest growing home infusion therapy companies in New England and is the region’s only non-profit home infusion provider. NELC is a hospital collaborative serving more than 70 hospital systems in Maine, New Hampshire, and Massachusetts. NELC was created by local hospitals to ensure their patients have access to a provider that reflects their commitment to excellence in patient care, quality, and service. Like our owner hospitals, NELC provides patient focused care.

New England Life Care has and continues to build a diverse, inclusive, and authentic workplace, so if you’re energized by this opportunity, but your experience doesn’t support every qualification in the job posting, we encourage you to apply! You still may be the person we are looking for!

New England Life Care currently has an opening for a Patient Accounts Coding Specialist / Biller. This is a full-time, hourly, non-exempt position. The normal working hours will be Monday – Friday from 8 : 00am until 5 : 00pm.

Although this is a remote position, we are only hiring in the following states : Massachusetts, New Hampshire, and Maine.

Job Summary : The person in this position is responsible for auditing medical records to ensure compliance with the organization's coding procedures and standards. Also reviews insurance payments and denials and recommends billing corrections.

Primary Responsibilities :

  • Audit and assign Per Diem codes to ensure PD codes are specific to therapy type.
  • Audit Medicare and Replacement Plan claims and DIF’s to ensure that correct claims are transmitted.
  • Maintain, create, and terminate employee web access to all payer websites. In addition, maintaining the access database in SharePoint.
  • Support the Coding Technician as needed in reviewing clinical documentation and entering diagnosis codes, and creating DIFs
  • Support the Coding Technician as needed in communicating with medical providers, patients, and insurance companies to obtain proper clinical documentation
  • Supporting the Coding Technician with assuring patient compliance with payer regulations regarding appropriate clinical documentation and insurance forms
  • Achieve performance appraisals with "meets expectations" or better
  • Demonstrate independence and competence and ability to review and navigate patient accounts and delivery tickets
  • Demonstrate independence and competence and ability to create and accept claims from clearing houses and work claim rejections
  • Demonstrate independence and competence in working daily billing reports
  • Demonstrate independence and competence and ability to teach basic billing knowledge, splitting claims, recognize billing and account errors, work To Do's and send out daily goal emails
  • Demonstrate independence and competence and ability to bill 20 or more clean claims a day
  • Demonstrate independence and competence and ability to bill using the payor sheets
  • Demonstrate independence and competence and ability to teach how to navigate through patient accounts and delivery tickets
  • Maintain an average of 95% or better in claim audits
  • All billing queues reviewed weekly
  • Billing rejections worked daily from queue

Educational / Professional Requirements

  • Bachelor’s degree preferred or 2 years’ experience in coding or medical records.
  • ICD-10 Certification
  • Medical knowledge of the Insurance industry
  • 3 years’ experience in healthcare setting processing healthcare provider claims or comparative experience in a healthcare setting required.
  • A working knowledge of government health insurance plan benefits and the rules & regulations for obtaining reimbursement required.
  • Experience with healthcare patient accounting / billing / collections computer applications including electronic claims processing preferred.
  • Working knowledge of Home Infusion Therapy billing & collection preferred.

    • Regulatory Requirements :

  • Knowledge of HIPAA Privacy and Security requirements
  • Working knowledge of federal / state fraud and abuse laws.

    • Required Skills :

  • Demonstrate a developed understanding of medical / insurance industry
  • Excellent customer service skills required.
  • Excellent communications (verbal and written) skills required.
  • Excellent organizational skills required.
  • Ability to work independently as well as part of a team required.
  • Practical experience with microcomputer systems and applications to include Microsoft Word and Excel required.
  • Demonstrated ability to identify, research and solve problems required.

    • It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.”

    Monday – Friday from 8 : 00am until 5 : 00pm

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    Patient Account Specialist • Canton, MA, US