Senior Medical Billing Specialist - Revenue Cycle (Full time - Days) Job Listing at Sutter Medical Foundation - Central in Sacramento, CA

JOB SUMMARY

The Senior Medical Billing Specialist provides technical and analytical support and input for the foundation revenue cycle including physician education on coding and billing protocols. The successful incumbant has extensive knowledge of the entire revenue cycle including; multiple coding certifications, extensive knowledge of billing protocols, strong education and presentation skills, the ability to take complex rules and create simply policies and procedures.

Principal Accountabilities

Approximately 10% of the incumbants time will be spent providing coding and billing education to the clinicians. An

important role of the entire Revenue Cycle Department is the education of clinicians on coding rules and regulations.

This is accomplished in a variety of ways; One on one meetings, group training/presentation events and other

educational materials. The Sr. MBS will develop and cultivate relationships with the clinicans that will allow them to

confidently present coding and billing information. This activity will result in positive working relationships and accurate

coding and billing documentation.

Approximately 5% of the incumbants time will be spent performing adhoc chart audits on identified clinician services.

This will be accomplished by employing Sutter Health approved audit processes and utilizing a variety of electonic and

manual tools (MDAudit, Excel spreadsheets and other tools as deemed appropriate by Foundation Management). The

tasks related to this activity will allow us to identify coding compliance issues, provide accurate information to

management and target education opportunities for the clinicians. Audit results are communicated to management,

Sutter Health Compliance, and the clinician based on specific direction from the incumbants supervisor and in a manner

most appropriate for the situation.

Approximately 5% of the incumbants time will be spent performing and/or assisting with front desk related activities.

Registration of patients in the practice management system. This includes the entering of demographic and insurance

information. Obtaining and entering both managed care and commercial insurance authoriztion information. This is

accomplished by contacting payers via a variety of methods (internet, phone, fax) and securing the necessary

authorization and then entering that information in the practice management system. Using the practice management

system will look up specific codes in the system to determine current fees. Will work in various system work queues to

resolve defects related to the billing process. This is accomplished by accessing the electronic work queues and

making corrections to the registration, insurance, coding, billing or other data in the practice management system to

correctly resolve the identified issue. Understands how and when to use ABN's. Updates staff and clinicians on payer

denial trends and mitigation strategies via education processes noted in Accountability #2. Other duties as assigned to

support the needs of the business unit.

Approximately 80% of the incumbants time will be spent reviewing paper and electronic data sources to ensure accurate

use of CPT, ICD-9 and HCPCS codes. By doing this we will ensure a compliant billing process that maximizes revenue.

This will be accomplished by using a variety of coding tools both electonic and hard copy (EncoderPro, AMA CPT

Manual, ICD-9 Manual, HCPCS Manual and other resources as appropriate). The Sr. MBS codes complex services

from clinical documentation (operative reports, radiology dictation, electronic health records etc...) The Sr. MBS will

analyze ICD-9/10 coding and linkage to insure both compliance and maximum revenue capture. This is accomplished

by reviewing both electronic and hard copy clinical and billing documentation. Provides mentoring, support and

education to Medical Billing Specialists. Periodically audits coding work performed by Medical Billing Specialists to

ensure accuracy and provide education. Sufficient understanding of the physician service agreement to communicate

efftively with the compenstaion team regarding coding impacts to physician compensation.

MINIMUM POSITION REQUIREMENTS

Education, including Licensure/ Certification/ Registration:

High School Diploma or equivalent. AA/AS Degree preferred. Current Certification in physician coding by American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC) and a minimum of one additional specialty coding certification (i.e. Interventional Radiology, Surgery etc...).

Experience:

Minimum of 3 years medical group coding & billing experience. Professional experience sufficient to recognize and make appropriate judgment regarding care center billing operational issues.

Knowledge / Skills:

In depth Knowledge of ICD-9, CPT and HCPCS coding. Expert knowledge and understanding of all insurance plans, including government, PPO and capitated plans. Computer billing, problem solving, and accounts receivable proficiency. Knowledge of medical terminology. Must maintain currency with CMS regulatory guidelines, insurance billing requirements, state and federal laws and regulations governing capitated, contractual and administrative writeoffs, third party liabilities and bad debt. Ability to function independently, identify problems and implement resolutions with minimal direction and guidance. Customer service skills sufficient to interface effectively with managers, clinicians, staff members and patients. Organizational skills sufficient to keep records and recognize inefficient work processes. Requires ability to learn all Care Center related computer functions and billing practices. Understanding of internal audit principles sufficient to support regional care centers. Communicate with physicians effectively to provide education on coding/billing errors and solutions. Skilled at using the Microsoft Office Suite to create analytical Excel spreadsheets, prepare Powerpoint presentations, and compose coherent documents in Word. Ability to use standard provide basic maintenance office equipment including but not limited to; telphone, copier, fax, credit card/ATM devices, Spot-check, scanning devices, laptop and desktop computers.