Bloomington Support Staff Job Specs

Job Title and Grade: Billing/Coding Specialist / SSOG

Job Code: 005881

Date: 01/2012 revised

Job Purpose

This is specialized work performing a variety of complex administrative and clerical tasks related to the review of medical documentation of physician services rendered to assure accuracy with federal, state and departmental guidelines for medical coding, and revenue processing.

Characteristic Duties and Responsibilities

Obtains and reviews medical records to ensure documentation provided is in compliance with clinical diagnosis, coding guidelines, federal, state and departmental regulatory standards.

Identifies and advises of deficiencies in documentation; analyzes and resolves provider claim rejections and denials related to coding issues.

Conducts billing in accordance with government and third party billing regulations. 

Compiles reports and identifies trends/problems in medical service area, documents and recommends possible solutions.

May provide interpretation, guidance and leadership support to transfer knowledge to individuals and areas served; assists with coding/billing training.

Knowledge, Skills, and Abilities

Ability to use various coding systems such as CPT, ICD9, ICD10, etc.

Knowledge of medical terminology.

Ability to use practice management software, standard office software and relational database system software.

Excellent written, verbal communication, interpersonal, organizational and analytical skills.

Knowledge of insurance carrier billing, coding and reimbursement guidelines.

Minimum Requirements

Education: High School Diploma or GED.  Certification (e.g. CPC, RHIT, RHIA CCA, CCS or CCS-P) required or must be attained within 12 months of employment.

Experience: Three years-experience with health care billing/coding.

The intent of this job specification is to provide a representative summary of the types of duties and responsibilities that will be required of positions given this title and shall not be construed as a declaration of the specific duties and responsibilities of any particular position.  Employees may be requested to perform job-related tasks other than those specifically presented in this specification.