Senior Medical Billing Specialist - Revenue Cycle (Full time - Days) Job Listing at Sutter Medical Foundation - Central in Sacramento, CA
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.
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...).
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.
Apply on Company Website
Get alerts for jobs like this:
Get jobs like this tweeted to you:Finance jobs in Sacramento, CA
View similar jobs:
Chase Wealth Management - Financial Advisor Associate
Chase - CA, California
Financial Advisor Associate - Chinatown Stockton
Chase - CA, California
Collectors Representative - IV
Apria Healthcare - Rancho Cordova, CA
Locate this job: