Medical Billing & Coding Analyst

Seward Community Health Center is seeking an experienced Medical Billing & Coding Analyst for a full-time position to support the billing department.

This position is eligible for remote work arrangements. Candidates throughout the State of AK are encouraged to apply here: https://www.sewardhealthcenter.org/careers.

SCHC is a federally-qualified health center. We welcome anyone in need of quality, affordable healthcare by providing integrated, patient-centered primary care to all who enter our doors. Our mission to identify and serve the healthcare needs of our community by providing quality, affordable services and promoting wellness, prevention, and partnerships.

Job Description

Reviews, analyzes and assures the final diagnoses and procedures as stated by the practicing providers are valid and complete. Accurately codes office and procedures for providers to ensure proper reimbursement. Provides education to the providers and billing staff to ensure proper completion of Electronic Health Records and proper assignment of ICD-10-CM, HCPCS (Healthcare Common Procedure Coding System) and CPT codes.

Ensures timely reimbursement from various third-party payors and patients by performing billing functions including submitting clean claims for payment, ensuring proper account documentation in the facility’s billing system, resolving denials, and independently pursuing follow up efforts on aged accounts under the supervision of the Revenue Cycle Manager and department leaders.

Coding Duties

Audits records to ensure proper submission of services prior to billing on pre-determined selected charges.

Supplies correct ICD-10-CM diagnosis codes on all diagnoses provided.

Supplies correct HCPCS/CPT code on all procedures and services performed.

Retro audits of services billed and educates providers and billing staff on audit outcomes.

Update providers and billing staff with correct coding information and new regulations.

Accurately follows coding guidelines & legal requirements and audits medical records to ensure proper coding completed and to ensure compliance with federal and state regulatory bodies.

Quantitative analysis - Performs a comprehensive review for the record to assure the presence of all component parts such as: patient and record identification, signatures and dates where required, and all other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered.

Qualitative analysis - Evaluates the record for documentation consistency and adequacy. Ensures that the final diagnosis accurately reflects the care and treatment rendered. Reviews the records for compliance with established reimbursement and special screening criteria.

Billing Duties

Documents billing activity on the patient account and submit claims to payers timely.

Answers patient and third-party questions and/or addresses billing concerns in a timely and professional manner.

Identifies and analyzes underpayments to determine the reasons for discrepancies and processes denials and appeals; examines claims to ensure payers are complying with contractual agreements.

Inputs and reviews posted payments to ensure accuracy; analyzes explanation of benefits to ensure proper reimbursements.

Communicates directly with payers to follow up on outstanding claims and resolve payment variances, responds to payer inquiries and concerns, and works to develop and maintain positive relationship with payers.

Monitors and reviews denial reason codes and underpayments to identify root causes; works with payer contracting and other areas of the revenue cycle, if necessary, to resolve issues.

Maintains superior understanding of claims management, third-party payer guidelines, state and federal regulations, and all other functions of the job; educates and trains other follow-up staff as needed. Ensures compliance and reports any suspected compliance issues to department leaders.

Collaborates with other departments to identify best-practice collections strategies, align goals, and improve collections.

Assists RCM in hiring and training new staff, develops training materials, and provides ongoing instruction to follow-up staff as needed.

Qualifications

High School Diploma

Medical Coding Certificate - RHIT (Registered Health Information Technician) or CPC (Certified Professional Coder) certification is required

A minimum of two years or more of experience in professional billing. Professional Billing certificate from an accredited institution, preferred.

Excellent attention to detail and follow-up.

Excellent interpersonal skills

Two years’ experience using ICD-10-CM, CPT, HCPCS, or equivalent

High proficiency in the use of computers, spreadsheet software, data entry, 10-key, and patient management software. Familiarity with Epic electronic health record is a plus.