Risk Billing Specialist - Hybrid

SUMMARY OF JOB DUTIES:

The person handling this position is responsible for ensuring all risk ICD-10 codes are properly documented with appropriate treatment plans on the encounter and these specific risk codes are attached to the correct CPT code for all VBC plans. This person is also responsible for making sure that the claim is fully processed by the payor so that they receive the HCC diagnosis.

ESSENTIAL JOB FUNCTIONS:

• Daily key punching into computer when needed to assure accuracy of billing for all services rendered in patients account in a timely manner.
• Ensure completion of documentation and coding on the EMR when needed on charges entered in patient's accounts for a correct and complete billing claim.
• Review clinical documentation and make sure accurate diagnosis codes and procedure codes are documented with the use of MEAT/TAMPER according to CMS guidelines
• Verify the appropriateness of the ICD-10 code to include required supporting documentation and treatment plans.
• Make sure that all pertinent diagnosis codes go out on the claim and add Dummy procedure codes when necessary.
• Communicate and Educate providers that are not correctly documenting Diagnosis and procedure codes.
• Strive to make sure all charges are entered with in 3 business days.
• Daily review of all postings before claim submission.
• Daily closing of batches and balancing of money posted for VBC/ DCE patients.
• Enter cash receipts if needed and assure correct allocations, distribution in accordance with the established protocol.
• Responsible for submitting all electronic claims for VBC/DCE plans
• Responsible for assisting with Billing Phone calls for VBC/DCE patients if need to provide exceptional customer service to patients with billing related questions.
• Resolving claim denials to VBC/DCE plans and issues with claims processing in a timely manner to ensure all claims and HCC codes are received and processed by payors.
• Entering Penny Charges of HCC codes that did not reach the payor.
• Effectively communicate with providers on claim documentation for charges submitted.
• Effectively audit and analyze charts.

MINIMUM REQUIREMENTS

• High School Diploma or Equivalent
• CPC Certification (or equivalent) required. CPC-A accepted
• CPB Certification preferred
• HCC Certification preferred
• 1-2 years of primary care billing experience preferred (outpatient/medical practice coding experience preferred)
• (2) Training or background in ICD-10 / CPT codes.
• Knowledge of medical terminology and billing practices.

KNOWLEDGE/SKILLS/ABILITIES:

• Ability to work under pressure.
• Ability to handle multi-functions/multi-tasks.
• Ability to solve problems and adapt to a fast-paced work environment
• Pay attention to detail, function autonomously
• Understanding of community-based organizations.
• Ability to effectively communicate with the medical staff and Office Managers.
• Knowledge of bookkeeping and office functions.
• Knowledge of CPT and ICD10 codes.
• Ability to work proficiently and efficiently on a timely manner.
• Knowledge of all payer codes.
• Knowledge of all programs offered by NHSI.

The position requires climbing, stooping, kneeling, crouching, reaching, standing, lifting, grasping, feeling, talking, hearing, repetitive motions, and finger use. Pushing and pulling are occasionally required.  Use of a computer, keyboard, and telephone along with various office machines is an essential part of the job. 

The above statements are intended to describe the general nature and level of work being performed by the Risk Billing Specialist. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.  The Risk Billing Specialist may be required to perform duties outside of their normal responsibilities from time to time as needed or as directed by supervision.