Medical Coding and Billing Specialist – LTC
Web ID: W7945
Classification: AccountingHealth Care - Medical
City: Wichita
State: KS
Compensation: $60,000.00 - $80,000.00
Education: Education or experience in third party reimbursement billing, collections, and compliance assurance for skilled nursing facilities including Medicare, Medicaid, Managed Care and Coinsurance preferred.
Benefits: Comprehensive Benefits Package
Job Description: Responsible for assigning and sequencing medical codes for diagnoses and procedures in accordance with established coding guidelines for long term care. This role requires adherence to ethical coding standards and involves reviewing provider documentation to ensure accurate coding for reimbursement and data purposes. This Specialist will also serve as a subject matter expert with the organization and participate in audits and documentation improvement reviews.
This position is also responsible for maintaining accounts receivables related to Third Party Insurances, which includes timely and accurate billing for services provided, collection of accounts receivable, claims submission to all payers and month-end processing.
CODING DUTIES AND RESPONSIBILITIES
- Assigns codes using ICD, CPT, and HCPCS.
- Sequences diagnoses and procedure codes according to coding guidelines.
- Maintains confidentiality of patient records and reports non-compliance.
- Reviews provider documentation to support assigned codes.
- Follows up on inaccurate documentation for clarification.
- Adheres to ethical coding standards and official guidelines.
- Meets departmental quality and production standards.
- Acts as a subject matter expert for coding leaders and peers.
- Participates in payer audits as a resource for coding-related inquiries.
- Processes coding claim appeals and rejections.
BILLER DUTIES AND RESPONSIBILITIES
- Responsible for accurate and timely billing of Third Party Insurance Claims and A/R follow-up as assigned, including, but not limited to: Medicare A & B / Managed Care / Private Insurance / Medicaid/PACE / Third Party Coinsurance.
- Maintain documentation to support third party claims submission and collections in accordance with defined policies.
- Manage A/R collections through claims submission, adjustments, phone calls, and appeals as needed on assigned communities, to meet and/or reduce day’s sales outstanding goals as established by the Director of Finance.
- Maintain A/R notes in the billing software with all outstanding A/R balances reviewed at minimum every 30 days.
- Prepare documentation/collection notes for monthly accounts receivable reviews.
- Identify, document, and communicate best practices and process improvement opportunities.
- Assist with cash posting as needed.
- Provide back-up and cross-training to other associates.
- Remain up to date on CMS regulations and policies, as well as federal and state regulations and policies related to healthcare, long term care facilities, and insurance.
- Prepare documentation for approval of A/R adjustments including, but not limited to: Contractual Adjustments / Charity Adjustments / Bad Debt Write Offs / Administrative Adjustments / Insurance Refunds.
- Maintain the monthly Medicare Bad Debt log for dual eligible and other accounts, with supporting documentation, to be approved for write off.
- Maintain ongoing metrics to provide continual self-assessment of performance and identification of process improvement opportunities.
- Attend and actively participate in trainings and meetings.
Responsible for assigning and sequencing medical codes for diagnoses and procedures in accordance with established coding guidelines for long term care. This role requires adherence to ethical coding standards and involves reviewing provider documentation to ensure accurate coding for reimbursement and data purposes. This Specialist will also serve as a subject matter expert with the organization and participate in audits and documentation improvement reviews.
This position is also responsible for maintaining accounts receivables related to Third Party Insurances, which includes timely and accurate billing for services provided, collection of accounts receivable, claims submission to all payers and month-end processing.
CODING DUTIES AND RESPONSIBILITIES
- Assigns codes using ICD, CPT, and HCPCS.
- Sequences diagnoses and procedure codes according to coding guidelines.
- Maintains confidentiality of patient records and reports non-compliance.
- Reviews provider documentation to support assigned codes.
- Follows up on inaccurate documentation for clarification.
- Adheres to ethical coding standards and official guidelines.
- Meets departmental quality and production standards.
- Acts as a subject matter expert for coding leaders and peers.
- Participates in payer audits as a resource for coding-related inquiries.
- Processes coding claim appeals and rejections.
BILLER DUTIES AND RESPONSIBILITIES
- Responsible for accurate and timely billing of Third Party Insurance Claims and A/R follow-up as assigned, including, but not limited to: Medicare A & B / Managed Care / Private Insurance / Medicaid/PACE / Third Party Coinsurance.
- Maintain documentation to support third party claims submission and collections in accordance with defined policies.
- Manage A/R collections through claims submission, adjustments, phone calls, and appeals as needed on assigned communities, to meet and/or reduce day’s sales outstanding goals as established by the Director of Finance.
- Maintain A/R notes in the billing software with all outstanding A/R balances reviewed at minimum every 30 days.
- Prepare documentation/collection notes for monthly accounts receivable reviews.
- Identify, document, and communicate best practices and process improvement opportunities.
- Assist with cash posting as needed.
- Provide back-up and cross-training to other associates.
- Remain up to date on CMS regulations and policies, as well as federal and state regulations and policies related to healthcare, long term care facilities, and insurance.
- Prepare documentation for approval of A/R adjustments including, but not limited to: Contractual Adjustments / Charity Adjustments / Bad Debt Write Offs / Administrative Adjustments / Insurance Refunds.
- Maintain the monthly Medicare Bad Debt log for dual eligible and other accounts, with supporting documentation, to be approved for write off.
- Maintain ongoing metrics to provide continual self-assessment of performance and identification of process improvement opportunities.
- Attend and actively participate in trainings and meetings.
Job Requirements:
- Professional Coder (CPC) certification or equivalent certification required
- Advanced training in Geriatric Behavioral Health coding from an accredited program preferred
- Minimum of 2 years of professional coding experience
- Minimum of 3 years of Accounts Receivable processing experience.
- Education or experience in third party reimbursement billing, collections, and compliance assurance for skilled nursing facilities including Medicare, Medicaid, Managed Care and Coinsurance preferred.
- Ability to define problems, analyze data, establish facts, and draw valid conclusions.
- Ability to read and interpret documents such as CMS regulations, Managed Care contracts and other instructions and procedure manuals.
- Ability to speak effectively before administrators, residents or employees.
- 3-5 years administrative and clerical experience preferred.
- Professional Coder (CPC) certification or equivalent certification required
- Advanced training in Geriatric Behavioral Health coding from an accredited program preferred
- Minimum of 2 years of professional coding experience
- Minimum of 3 years of Accounts Receivable processing experience.
- Education or experience in third party reimbursement billing, collections, and compliance assurance for skilled nursing facilities including Medicare, Medicaid, Managed Care and Coinsurance preferred.
- Ability to define problems, analyze data, establish facts, and draw valid conclusions.
- Ability to read and interpret documents such as CMS regulations, Managed Care contracts and other instructions and procedure manuals.
- Ability to speak effectively before administrators, residents or employees.
- 3-5 years administrative and clerical experience preferred.