Responsible for the review, correction, consolidation, and submission support of claims involving overlapping encounters across multiple billing entities. This role ensures compliance with payer regulations related to same-day services, 24-hour and 72-hour billing requirements, and medical necessity standards. The specialist analyzes encounters for medical relation, determines appropriate encounter combinations, moves diagnoses and charges as needed, and supports the submission of accurate claims for reimbursement.
The role collaborates with coding, revenue integrity, patient access, PFS, and clinical departments to resolve billing issues, manage overlapping encounter rules, and support revenue cycle goals. It also requires maintaining compliance with HIPAA, payer requirements, and organizational policies.
Required Qualifications
- High school diploma or GED equivalent
- 1+ year of coding experience or completed education in a medical coding/billing program
- 2+ years of UB/facility billing experience
- CPC, CCS, or CCA certification, or ability to obtain within the first 6 months of hire
- CPFSS certification within 12 months of hire
- Ability to analyze medical records and determine medical relation between encounters
- Knowledge of medical terminology, anatomy, physiology, signs, and symptoms as related to healthcare billing, coding, and reimbursement
- Knowledge of revenue codes, CPT/APC/HCPCS, ICD/DRG coding, NCCI, HIPAA, CMS 1500 forms, UB-04s, remittance advice, and itemized statements
- Familiarity with revenue cycle workflows and systems such as Cerner, Trisus, Forvis, Quadax, KaiNexus, 3M, and Experian
- Ability to research, review, analyze, and interpret federal, state, and local billing regulations
- Strong analytical, organizational, time management, research, and problem-solving skills
- Ability to manage multiple tasks and present information to leadership and other stakeholders
- Strong interpersonal and communication skills
Preferred Qualifications
- Associate's degree in a healthcare-related field
- Certified Professional Biller (CPB) certification
Location
Ohio, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 month ago