HOW WE CARE FOR YOU:

At Rochester Regional Health, we are dedicated to getting health care right. Our robust benefits and total rewards foster employee wellbeing, professional development and personal growth. We care for your career while caring for the community.

Pension PlanRetirement PlanComprehensive Benefits PackageTuition ReimbursementBenefits Effective Date of HireSame Day Pay through Daily Pay

SUMMARY

The primary responsibility of the SCHI Biller and Coder, Lead is to be the subject matter expert & be responsible for the more complex tasks within the department, i.e. HB work queues, audit result follow through, specialized billing. Additionally, participating in the daily work related to review of clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10-CM and/or CPT codes for billing, internal and external reporting, research, and regulatory compliance. Under the direction of the Business Office Manager, accurately codes conditions and procedures as documented in the ICD-10-CM Official Guidelines for Coding and Reporting and/or CPT Assistant. Demonstrates knowledge of reimbursement methodologies and applies to assigned charts in order to optimize reimbursement and/ or resolve regulatory edits. Submits bills to 3rd party payers and performs follow-up verification activities to assure collection of outstanding receivables. Reviews and resolves error reports associated with billing process, identify and report error patterns, and, when necessary, assists in design and implementation of workflow changes to reduce billing errors

STATUS: Full Time          

LOCATION: Sands-Constellation Heart Institute, Brighton      

DEPARTMENT: Sands-Constellation Heart Institute

SCHEDULE: Monday - Friday Days (Hybrid)

        

ATTRIBUTES

3+ years of healthcare billing, reimbursement, collections, and denials management 1 Year of ambulatory coding Proficient working knowledge of assigned receivable systemsFamiliarity with ICD-9 diagnosis and procedure codes as well as CPT/HCPCS codes  Proficiency in a variety of computer applications, spreadsheet applications, and common office equipmentGeneral knowledge of Medicare, Medicaid, and insurance compliance issues   Knowledge of UBO4 billing form and 1500F05 specific payor requirementsFlexibility and ability to work as a team player.Ability to handle simultaneous tasks paying great attention to detailExcellent communication skills including both oral and written as well as interpersonal skillsExcellent problem solving and follow through skills Strong communication, refined problem solving, analytical, and PC skills Advance coding certification credential: CCS, CCS-P, CPC, CPC-H General knowledge of Medicare, Medicaid and insurance compliance issues preferredExcellent email and project management skills. Strong ability to multi-task and work in a fast paced setting with ability to prioritize as appropriate. Strong Analytical and problem solving skills

RESPONSIBILITIES

CODING & DOCUMENTATION: Assign codes for diagnosis, treatments, procedures, and visits according to the appropriate outpatient encounter classification system. Review provider documentation to determine appropriate primary diagnosis and procedural and ambulatory office coding. Extract required information from source documentation and enter into billing system. Provide assistance and feedback to manager (and, at times, physicians) regarding clinical documentation opportunities, coding reimbursement issues, and quality improvement review process. Monitor electronic and paper billing for 100% Charge Review to assure timely and accurate claim submission. Correct errors and submits corrected claims when necessary. Utilize online insurance portals to access and reconcile claims. Monitor and reconcile aged receivables to avoid timely filing and other final denials. Accurately enter data, adjustments, and documentation of accounts. Assist in analysis of billing, coding, accounts receivable and other related data needs, as requested. Respond to patient inquiries in an accurate, timely, professional manner. Responsible for developing and implementing the training plan for new staff on respective job responsibilities. Apply understanding of insurance verification and authorization request process to ensure appropriate resolution to denial of claims to understand how best to resolve the issues. Assists Supervisors/Managers in overseeing the daily billing operations, providing feedback on team issues and performance.

LEADERSHIP & DEVELOPMENT: Identify potential billing compliance issues and inform leadership team accordingly. Participate in committees focused on process improvement. Coordinate timely and accurate completion of special billing projects identified by leadership to achieve department goals. Demonstrate working knowledge of payer contracts and reimbursement methodologies. Crosstrain on multiple billing platforms as needed. Interact with various departments such as HIM, Revenue Integrity and FERC to obtain information and resolve billing issues. Assist in coordination and implementation for new services, (new MD practices, hospitals, service lines etc). Run reports and process charge reconciliation.  Work with managers on filing appropriate charges based on report. Research and correct hospital based work ques assigned to department. Act as point of contact for SCHI Billing staff in SCHI Business Managers absence.  
 

EDUCATION:

LICENSES / CERTIFICATIONS: 

PHYSICAL REQUIREMENTS:

S - Sedentary Work - Exerting up to 10 pounds of force occasionally Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee’s physician or delegate will be considered for accommodations.

PAY RANGE:

$18.25 - $23.31

CITY:

Rochester

POSTAL CODE:

14618

The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.

Rochester Regional Health is an Equal Opportunity/Affirmative Action Employer.
Minority/Female/Disability/Veterans by a prospective employee and/or employee’s Physician or delegate will be considered for accommodations.