Senior Billing and Coding Specialist

A. Primary Purpose of Job:

Create and assign codes and charges for insurance billing. All procedures performed in compliance with the philosophy of MedWise’s standards of practice and regulations of government agencies by performing the following duties:

B. List the major functions for this position starting with the most important. (maximum of 10 functions).

1. Insurance billing and coding.
   1. Assign and enter procedural and diagnostic codes for all services. Post facility charges into the computer system.
   2. Create and mail/electronically transmit insurance billings daily.
   3. Resubmit and appeal claims as required. File secondary claims.
   4. Run daily update and insurance exception reports and files. Post payments and adjustments to account daily.
   5. Contact insurance companies to determine the reason for nonpayment and send additional information as may be requested. Follow-up on insurance correspondence and/or telephone inquiries.
   6. Mail patient statements according to acceptable cycle billing process.
   7. Responsible for minimizing days in A/R.
   8. Report all undesirable matters, services and facilities requiring correction.
      • • 75% of total job

2. Customer Support
   1. Provide consistent and efficient customer service using empathy, compassion, and good judgement.
   2. Assist patients with questions regarding insurance and/or account balances.
   3. Make financial arrangements regarding patient balances.
   4. Collection efforts. For accounts with a credit balance, review for accuracy and give to the Revenue Operations Manager for a refund.
   5. Comply with all HIPAA regulations to maintain patient rights to privacy by not discussing privileged information outside the work area and preserving the patients’ dignity at all times.

• 20% of total job

3. Miscellaneous Projects –
   1. Assist Revenue Cycle Supervisor and Corporate Support Staff by researching and completing miscellaneous projects.
      1. Perform scanning, copying, and filing functions, as needed.
      2. Assist other billing department duties as requested.
      3. On-going evaluate current processes and recommend updates, changes, adjustments as needed.
   2. Must review MedWise electronic communications.
   3. Other Duties as assigned.

• 5% of total job

C. Position in Organization

Reports to: Reports To: Revenue Cycle Supervisor

Directly supervises: Directly Supervises: N/A

Indirectly supervises: Indirectly Supervises: N/A

D. Relationships

Inside the Company: Inside the Company: All personnel, including QuikTrip employees.

Outside the Company: Outside the Company: Patients, third party payors, collection agencies, vendors, and the general public

E. Position Specifications

The required specifications (education, experience, and skills) are those that the employee must have to hold the position. Applicants applying for this position must possess the required specifications in order to be considered for the job. The desired specifications are those that are not required for the employee to hold the position, but the employee should try to obtain the desired education, experience, and/or skills to be effective and successful in the position.

1. Required education: High school degree or GED

Certified professional coder with 2+ years of medical billing and CPT coding experience. Knowledge of government and other third-party payor requirements and policies.

4. Desired experience: Experience with physician or urgent care coding preferred.

5. Required skills: People-oriented, highly organized and self-motivated, attention to detail, and the ability to work independently.

6. ADA Information (not to be revised by employee)

Sensory Requirements:

Worker must be able to hear, see and speak to supervisors, co-workers, internal customers and vendors, and to identify and deal with such via the telephone or in person in order to accomplish job responsibilities.

Physical Requirements:

This job requires that the worker be able to sit or stand for extended periods of time to perform work duties. Worker is required to hold items such as writing utensils.

Mental Requirements:

Worker must be able to concentrate and perform work with many interruptions (persons and telephone). He/she must be able to conceptualize work delegated by manager in order to complete it correctly. He/she must learn new process as MedWise changes. He/she must be able to think through, reason and solve problems. He/she must maintain his/her composure with internal and external customers.

8. Does this position require the use of a computer? If so, estimate the amount of time spent on the computer during the work day?

Yes-Majority of the work day.

Yes – majority of the work day.

9. What is the extent of direct or indirect impact on sales, expenses, profits, etc.?

Most programs managed by this position have a direct impact on profits (turnover, compensation, relocation, awards, and training/education) with the remaining programs having an indirect impact since they affect employee morale.

F. List all List all confidential information regularly accessible to this position.

Compensation for employees, other HR materials.