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
Millions of jobs, with real people getting hired every day
200,000+
New jobs added daily
7,000,000+
Verified job listings
1,000,000+
Tailored applications submitted
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.
