Medical Billing / Coding Specialist

Medical Billing / Coding Specialist

Position Summary The WPPA Medical Billing / Coding Specialist is responsible for coordinating, verifying, distributing and managing all billable services.

Essential Functions and Responsibilities Includes the Following : 1. Understands and adheres to the WPH Performance Standards, Policies and Behaviors 2. Fulfills responsibilities as assigned which may include a. Coordinating with clerical / clinical staff to obtain insurance / charge information for all patients b. Accurately assigns CPT, ICD-9 / ICD-10, HCPCS codes based on documentation presented c. Verifying and completing charge information in database and generates bills d. Processing and distributing copies of billings according to office policies e. Maintaining required billing records, reports, files, etc. f. Responding to tasks in a timely manner to facilitate resolution of any claim related issues 3. Follows New York State requirements for the appropriate and timely submission of all coding, including worker’s compensation and / or no fault visits, and daily reviews of pending charges for all providers 4. Works collaboratively and maintains effective communication with internal and external stakeholders 5. Works independently to prioritize, organize, and manage a daily assignment within the normal work period 6. Recognizes problem situations, sets priorities appropriately, offers feasible solutions, initiates appropriate actions 7. Fulfills organizational responsibilities as assigned including respecting / promoting patient rights; responding appropriately to emergencies; communicates concerns / problems relating to patients and / or staff with immediate supervisor 8. Utilizes appropriate steps in the decision making process to include recognition and priority setting relating to patient care and practice based issues 9. Attends in-services as required / requested 10. Cross-trains as back up to other business office positions as requested 11. Communicates all issues and concerns to appropriate parties effectively in an effort to facilitate resolution and maintain compliance with related laws and regulations 12. Demonstrates understanding of health insurance policy results in terms of proper claim adjudication 13. Demonstrates aptitude in how to interpret the coding guidelines for CPT, ICD, HCPCS 14. Demonstrates proficiency in computer software including Meditech, EPIC, Microsoft Office Suite 15. Maintains ongoing expertise in relevant coding chapters and reviews these annually for changes, new and deleted codes 16. Adheres to WPH infection control standards including, but not limited to hand hygiene 17. Completes annual mandatory requirements including Occupational Health Requirements 18. Performs all other related duties as assigned.

Education & Experience Requirements High school diploma or GED required. Some college preferred. Knowledge of billing practices and clinical policies and procedures. Knowledge of coding and clinic operating policies. Minimum 1 year of billing experience in a healthcare organization. Coding certification or relevant coursework preferred.

Core Competencies Ability to understand and interpret policies and regulations Ability to read and interpret medical charts for billing and coding purposes Ability to examine documents for accuracy and completeness Ability to communicate effectively both verbally and written and work with others Ability to concentrate on fine details with constant interruptions Perform multiple duties in a high volume area Ability to deal professionally and efficiently with all levels of management and external constituencies Self-starter, self-motivated and ability to work without supervision Flexible, organized and able to set priorities Demonstrates team work and adaptability.

Physical / Mental Demands / Requirements & Work Environment Ability to perform computer work for extensive periods of time Occasionally move and / or transport of 15 to 20 pounds Requires movement about the department frequently throughout the day Ability to remain in stationary position for extended periods of time Ability to respond to frequent phone calls May be exposed to chemicals necessary to perform required tasks. Any hazardous chemicals the employee may be exposed to are listed in the hospital’s SDS (Safety Data Sheet) data base and may be accessed through the hospital’s Intranet site (Employee Tools / SDS Access). A copy of the SDS data base can also be found at the hospital switchboard, saved on a disc.

Primary Population Served Check appropriate box(s) below : Neonatal (birth – 28 days) Patients with exceptional communication needs Infant (29 days – less than 1 year) Patients with developmental delays Pediatric (1 – 12 years) Patients at end of life Adolescent (13 – 17 years) Patients under isolation precautions Adult (18 – 64 years) Patients with cultural needs Geriatric (>

65 years) All populations Bariatric Patients with weight related comorbidities Non-patient care population The responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of White Plains Hospital.

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