Our Commitment to Diversity
ZERO TO THREE is proud to be an equal opportunity employer, committed to inclusive hiring, advancement, and professional development and is dedicated to diversity in its work, its staff and with community partners. This is an exceptional opportunity for a professional who shares our commitment to diversity, equity and inclusion and supports our mission to enhance outcomes for ALL children.
HealthySteps is a unique, evidence-based pediatric primary care program committed to healthy early childhood development and effective parenting so that all children are ready for kindergarten and success in life. This position will work with the HealthySteps National Office Policy and Finance team to determine applicable billing codes and requirements for HealthySteps services. The Specialist will serve as a subject matter expert to the HealthySteps network of sites across the country and provide education, guidance and technical assistance to HealthySteps sites on reimbursement for billable services at the state-level to promote long-term site sustainability. This individual will also research reimbursement policy changes at the federal and state levels and determine their applicability for the site network.
Essential Duties and Responsibilities
- Serve as revenue capture, reimbursement, and billing and coding subject matter expert for the HealthySteps National Office and Policy and Finance Team including identifying appropriate codes for billing HealthySteps services.
- Provide guidance to the National Office staff and HealthySteps sites on relevant CPT, HCPCS and ICD10 content as well as coding and billing related to pediatric, caregiver, parental and family services in the primary care setting.
- Work with the HealthySteps Policy and Finance Team to determine potential reimbursement and billing options for HealthySteps national site network.
- Research and interpret changes to insurer, state and federal guidance on reimbursement and billing and coding related to pediatric and family practice services.
- Attend seminars and workshops, as applicable, for updates on new pediatric and family practice coding rules and regulations.
- Develop reimbursement, billing and revenue capture educational guidance for HealthySteps site network, in collaboration with National Office staff, including creation of state-specific billing and coding toolkits to disseminate to the site network.
- Assist HealthySteps sites with researching and determining potential billing codes and reimbursement/revenue capture opportunities at the state and site-levels.
- Work with HealthySteps sites and staff to address ongoing reimbursement questions, provide guidance to avoid common coding errors and share mechanisms to drive increased revenue capture.
- Lead educational and technical assistance sessions and webinars, for the HealthySteps site network, to provide reimbursement and billing and coding guidance to assist with funding HealthySteps service delivery.
- Perform other duties as assigned to ensure the efficient and effective functioning of the project.
Essential Skills and Experience
- At least (5) five years of experience working in revenue capture, reimbursement, and billing and coding in both a health system and payer environment, with pediatric and family medicine experience required.
- Knowledge of pediatric, behavioral health, care coordination, and infant and early childhood mental health codes, and their respective guidelines as well as billing for two-generation approaches to care.
- Demonstrated experience educating clinicians and clinic staff on revenue capture through reimbursement and coding improvements.
- Knowledge of billing and coding under Medicaid state and federal requirements as well as commercial insurance.
- Ability to interpret and appropriately communicate federal, state and insurer billing regulations.
- Experience conducting research on specific topics, synthesizing findings for various audiences and purposes, and presenting research and findings to internal and external stakeholders.
- Familiarity with billing requirements for federally qualified health centers (FQHCs) a plus.
- Knowledge of billing for Indian Health Service and TRICARE services a plus.
- General knowledge of DC:0-5 a plus.
- Up to 20% travel may be required.
- Encourages and practices critical thinking.
- Is self-reflective and empathetic.
- Recognizes the influence of workplace relationships on outcomes and results.
- Maintains a respectful and accepting approach to others.
- Awareness of the influence of the larger context on individual behavior.
- Collaboratively and creatively supports the work efforts of colleagues at all levels and in all areas of the organization.
- Exhibits work behaviors consistent with the organization’s core values.
- Represents ZERO TO THREE’s reflective practices.
Bachelor’s degree. Medical coding certification from the American Academy of Professional Coders or the American Health Information Management Association. Current on continuing medical coding certification education credits.
While performing the responsibilities of the job, the employee is required to use finger dexterity as well as hand dexterity to use a computer keyboard and be capable of reading a computer screen. Also many need to remain seated for long periods of time and have the ability to perform repetitive motions. Employee may frequently be required to walk. The employee may need to grasp objects, including a writing instrument, stand, push or pull objects, bend, squat, reach or kneel. Vision abilities required for this job include close vision for data preparation or analysis and expansive reading.
The work conditions described here is representative of those an employee encounters while performing this job. Depending on work location, the incumbent will typically work indoors in a heated and air-conditioned office, with a mixture of natural, incandescent and fluorescent light with low to moderate noise levels or be subject to working conditions conducive to a home office. When travel is expected, the incumbent will be exposed to outside environmental conditions during those times.
ZERO TO THREE is proud to be an Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individuals with Disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or national origin.