About This Role
This position ensures the smooth operation of the Billing Department by collaborating with finance and revenue cycle leadership. The specialist organizes workflows, sets deadlines for staff and vendors, and provides analytical support on revenue cycle matters. This role is critical within a Federally Qualified Health Center (FQHC), managing financial processes related to patient billing and reimbursement, including internal provider billing and coding audits and claims follow-up.
Responsibilities
- Assign accurate medical codes (ICD-10, CPT, HCPCS) to diagnoses and procedures performed by healthcare providers
- Ensure coding compliance with federal and state regulations, payer policies, and industry standards
- Review medical records to abstract relevant information for coding purposes
- Lead and support the CFO, Director of Finance and Revenue Cycle, and finance team in analyzing opportunities for business performance improvement related to coding practices
- Prepare and submit accurate medical claims to insurance companies or government payers
- Verify insurance eligibility and benefits for patients, as needed
- Assist with claims follow-up to promptly resolve billing discrepancies and denials
- Collaborate with healthcare providers and relevant department staff to resolve billing discrepancies
- Provide analytical support to other departments on revenue cycle issues
- Monitor billing metrics, generate reports to track revenue performance, and identify areas for improvement
- Conduct coding audits to ensure coding accuracy and compliance with coding guidelines and regulations
- Present best practices based on audits to prevent findings and recommend documentation improvements for maximum reimbursement
- Identify and rectify coding errors or discrepancies to optimize revenue cycle performance
- Maintain compliance with coding and billing regulations, including HIPAA, CPT coding guidelines, and local coverage determinations
- Ensure accurate and complete documentation of patient encounters to support coding and billing processes
- Conduct internal audits to ensure accuracy and compliance in billing practices
- Ensure timely and accurate submissions for Medicare and Medicaid WRAP billing and NJ Letter of Agreement (LOA) billing
- Generate reports and analyze revenue cycle metrics such as coding accuracy, claim submission timeliness, and denial rates
- Identify trends, patterns, and opportunities for revenue enhancement or process improvement
- Present findings and recommendations to management or stakeholders
- Provide updates to management on billing and collection activities
- Work closely with Revenue Cycle Manager, Supervisor and/or Director to establish priorities in duties/responsibilities
- Work with the Patient Access department (Medical and/or Dental) to resolve billing and registration issues
- Manage relationships with outsourced revenue cycle vendor(s)
- Attend Medical Staff meetings and deliver special presentations as needed
- Collaborate with all employees to achieve Henry J. Austin Health Center's goals and objectives, following established policies and procedures
- Demonstrate willingness and flexibility to perform tasks and projects assigned in the Finance Department
- Stay updated on healthcare regulations and reimbursement trends to optimize revenue generation
- Train and educate staff on FQHC billing and coding requirements as needed
- Oversee month-end and year-end closing processes, as well as external audit preparations
- Assist in training new staff members on revenue cycle processes and procedures
- Keep up with multiple deadlines, project goals, and a high volume of work
- Perform any additional duties as may be assigned by supervisor, manager or director
- Work on special projects as needed/assigned
Requirements
- Minimum of 4-5 years of experience
About the Company
Henry J. Austin Health Center's goals and objectives are achieved by its employees following established policies and procedures.
