EMPLOYER INFORMATION: Clifford Beers is a mental health clinic serving children and families. Our mission is to provide integrated services addressing mental, physical, and social determinants in order to improve health, resiliency and quality of life for children, families and communities.
PURPOSE: Reporting to the Manager of Revenue Cycle, this position is primarily responsible for reviewing claims and keeping departments up to fate on coding guidelines and processes. Assisting with processing of commercial and Medicaid claims. Additionally, this position will also provide needed support for revenue reporting, audits and other billing functions.
KEY RESPONSIBILITIES:
? Review of patient procedure notes and translation of services into correct behavioral health codes. Input behavioral health data into billing system
? Review and Monitor new and updated coding guidelines and advice staff if any coding guidelines affect clinical documentation and billing.
? Ensure codes are accurate and sequences correctly in accordance with government and insurance regulations.
? Timely importing of electronic remittance advices (ERAs) Strict monitoring of insurance appeals and Accounts Receivable balances.
? Research and provide documentation for information in cases where coding is complex and unusual.
? Coordinates coding and payment issues with other areas and departments as required.
? Follow up with clinicians on any documentation that is insufficient or unclear.
? Develop and maintain relationships with all third party payers and resolve collections issues.
? Work in partnership with the Compliance team
? Monitor and work aging accounts as needed.
? Cross train within department to provide coverage when necessary.
EDUCATION and EXPERIENCE:
? 3+ years of Medical Billing experience
? Experience in coding and billing in behavioral health care.
? Must be well versed in ICD-10 and CPT coding
? Certified Professional Coding (CPC) Certification preferred.
? Experience reconciling and resolving billing transactions with the accounting general ledger system is a plus.
? Experience working within an Electronic Health record preferred, experience with Carelogic EHR a plus.
COMPETENCIES: Must demonstrate the following competencies:
? Diversity and Inclusion: Foster an environment in which all members of the Clifford Beers community, from staff to partners and clients, are treated equitably and are able to contribute fully and meaningfully to the mission of Clifford Beers. Employees must make every effort to: o Treat others with respect o Practice cultural humility o Elicit and welcome different points of view
? Integrity: Act ethically with honesty and consistency regardless of the situation. Employees must make every effort to: o Be accountable for his or her own actions o Make decisions based on what is better for the families and employees o Build and maintain trust among co-workers and our families o Uphold honesty in all actions
? Excellence: Commitment to deliver outstanding practices in both managing the organization, service delivery, and collaborating with partners. Employees must make every effort to: o Utilize data and research to provide the highest quality of care o Regularly participate in professional development to stay abreast of most recent and progressive practices o Promote continuous quality assessment and improvement
? Communication: The ability to express oneself clearly and professionally both in writing, conversations, and in nonverbal communication with others. Employees must make every effort to:
Oral Communication
- Speak clearly and in an organized manner that can be easily understood
- Express ideas concisely and respectfully
- Summarize or paraphrase his/her understanding of what others have said to verify understanding and prevent miscommunication
- Hold herself or himself accountable for pitch, speed, tone and volume of voice while speaking
- Show understanding of professional and cultural implications of body posture, stance, gestures, proximity to listener, facial expressions and appearance
Written Communication
- Write clear and concise sentences devoid of grammatical and spelling errors
- Tailor writing style to the audience of the message
- Write in a respectful and tactful manner
SKILLS: ? Demonstrate high level expertise with Microsoft Excel and other MS Office software
? Strong third party billing knowledge with both Medicaid and commercial carriers.
? Demonstrated ability to proactively ensure that the program[s] runs smoothly and staff is fully supported.
? Demonstrated ability to effectively allocate time to complete work; delegate appropriately; coordinate and manages employees’ and own schedule to maximize return and decrease downtime.
? Ability to involve others in team decisions and actions; values and elicits differing opinions to strengthen results.
? Ability to adhere to the team’s expectations and guidelines and demonstrate personal commitment to the team