Planned Parenthood Great Plains (PPGP) seeks a Coding and Billing Specialist for this 21st Century health care provider and advocacy organization dedicated to its mission to uphold the standard for providing high quality sexual and reproductive health care, provide education that promotes informed proud and authentic sexuality, and change the culture through proactive advocacy to ensure equality in reproductive and sexual decision making.
The successful candidate will be passionate about the mission of PPGP and willing to work in a faced-paced, changing work environment. The Coding and Billing Specialist is responsible for conducting reviews of Electronic Medical Records (EMR) documentation of patient encounters to ensure coding accuracy and documentation adequacy. The professional will work collaboratively with clinical providers to improve billing and coding integrity while seeking and identifying trends and opportunities for coding optimization. The incumbent will regularly conduct coding reviews of CPT, ICD-10, and modifier utilization. He/She/They will provide feedback and focused educational programs on the results of auditing, and review claim denials pertaining to coding.
RESPONSIBILITIES OF THE CODING AND BILLING SPECIALIST
- Coordinates schedules and performs reviews of professional services and documentation performed by medical providers.
- Evaluates the quality of clinical documentation to identify incomplete or inconsistent documentation that could impact the quality of data being reported.
- Prepares written reports of the audit findings to internal leadership, clinical leadership, and providers.
- Develops educational presentations and training material.
- Provides education for both providers for appropriate CPT, ICD-10, and modifiers based on supporting documentation and EMR charge capture support.
- Serves as a liaison point of contact for clinical coding inquiries and communication for billing revenue cycle.
- Seeks to establish collaborative relationships with physicians, clinical providers, IS, Revenue Cycle, and administrative leadership in the support of coding education and documentation adequacy.
- Assists with claim denial reports to ensure optimal reimbursement.
- Analyzes billing trends to identify areas of non-compliance and prepares regular reports on review findings to appropriate committees.
- Collaborates with PPGP’s third party billing vendor and Billing Coordinator, to ensure all invoices are submitted to insurance payors and patients in a timely manner. Complies with all legal requirements regarding coding procedures and practices.
- Under the Direction of the Vice President of Health Services, works with health center managers, to streamline process and improve efficiency, quality and timeliness of insurance verification and collection procedures.
- Remains current on trends in revenue cycle activities and ensures compliance with regulatory requirements and changes (PPFA, ARMS, Medicaid, etc.) that may impact financial viability.
- Demonstrates adherence to the “In This Together” principles when dealing with co-workers, staff and patients.
- Supports and carries out PPGP’s Mission: upholding the standard for providing high quality sexual and reproductive healthcare; providing education that promotes informed proud and authentic sexuality; changing the culture through proactive advocacy to ensure equality in reproductive and sexual decision making.
- Supports PPGP’s Strategic Plan and ensures accountability through successful implementation of assigned objectives.
- Maintains technical knowledge by attending educational workshops, reviewing professional publications, and participating in relevant webinars.
- Maintains confidentiality of all agency information, employee nonpublic personal information (NPI) and personal health information (PHI), as well as records directly or indirectly identifying any person currently or formerly receiving services from PPGP.
- Accepts and uses supervision, direction, and consultation to maximize available resources in the completion of work duties.
- Additional responsibilities will be assigned as needed to maintain and improve effective functioning of the Health Services and Finance departments and to advance PPGP’s mission.
- All job responsibilities will be carried out under the direction of PPGP’s policies and procedures.
REQUIRED KNOWLEDGE, SKILLS AND ABILITIES
- High School diploma or GED Required. Associate’s degree preferred. Advanced working knowledge of CPT and ICD-10 medical coding guidelines and regulations including compliance and reimbursement. Knowledge of medical terminology necessary to correctly code provider diagnosis and services. Minimum 2 years working experience in reviewing and assigning accurate medical codes for diagnoses, procedures, and services performed by physicians and other qualified healthcare providers. Certified Professional Coder (CPC) certification required.
- Demonstrate proficiency with Microsoft Office applications including Word, Excel, PowerPoint, Outlook
- Demonstrate proficiency with Electronic Medical Records (EMR) software; prior experience with NextGen preferred.
- Demonstrate thorough understanding of third-party payer contracts, medical reimbursement, provider enrollment and compliance.
- Effectively present information to groups and individuals through verbal and written formats.
- Demonstrate the ability to recognize, understand, accept and appreciate the value of workplace diversity; respect the practices, values, and points of view of other individuals and groups. Be able to communicate with a diverse group of staff from various professional backgrounds.
- Work effectively in a team, creating collaborative relations with others.
- Set priorities and organize a variety of concurrent projects, handle pressure, manage time effectively, and follow through reliably.
- Accomplish tasks through concern for all aspects of the job with attention to detail and accuracy.
- Express ability to complete activities/projects in a timely manner, on or before scheduled deadlines, with minimal errors.
- Demonstrate self-motivation and ability to work independently within a fast paced office.
- Effectively support and carry out PPGP’s mission.
- Travel to all parts of the facility and throughout the affiliate network including Arkansas, Kansas, Missouri and Oklahoma; must have access to reliable transportation.
- Work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Work is performed inside and outside the facility and throughout the affiliate network including Arkansas, Kansas, Missouri and Oklahoma; must have access to reliable transportation.
- Occasional weekend and/or evening work may be necessary.
- Use of hands and fingers involved in work which is preformed through the extensive use of computer systems, email, phone and fax machines, copiers and scanners.
- Handwritten paperwork is performed.
- Employee is required to sit for extended periods of time.
- Must operate various input/output devices including keyboard and computer mouse. Employee has prolonged exposure to computer monitors.
- The noise level in the work environment is usually moderate.
- This position carries some level of exposure to conflict and/or antagonism by those opposed to the mission of PPGP.
- A cubicle within a larger work environment will define workspace.
Only those candidates including a cover letter with salary information will be considered for this position.
Planned Parenthood Great Plains is an equal-opportunity employer committed to diversity and inclusion in the workplace. We encourage Minority, Disabled, Protected Veterans, and LGBTQIA candidates to apply. EOE/AA