Finance Billing & Coding Coordinator Apprenticeship Internship
Job Description
**LAMOUR Clinic and LAMOUR Community Health** Institute were developed to provide an essential link between the community, the healthcare, human services system and educational system. Our staff are multicultural providers that speak and understand the cultural needs of the community. Our specialty is using a blend of integrated behavioral health program services that meet the needs of children, adolescents, families, and adults and providing services in the community.
We are a Multi-Services Community Based Agency that is committed to advocating and providing community-based, culturally competent, and comprehensive programming services. We have a responsibility to the communities we serve and to the staff we employ to help them develop their potential.
**LOCATION:**
Main office in Randolph and Braintree Massachusetts with satellite locations in various states. Administrative staff can be designated to work at any of our office sites within the regions we cover based on positions that are available and travel is required at times.
**JOB SUMMARY:**
The Billing & Coding Coordinator oversees billing and coding operations and management, and is responsible for general day-to-day billing, financial administration of operational duties, and administration for the Billing & Coding team and finances processes. The Coordinator will set up, maintain, and oversee all web-based applications regarding billing and coding EMR, and Clearing House. They will supervise the Billing & Coding Documentation Specialist, and oversee their daily duties regarding training, billing, coding and coordinating, financial coordination, documentation coordination, and directly reporting to the Accounts Receivables in regard to all financial and accounting activities, and any additional duties. The Coordinator is responsible for coordinating resolution of complex coding denials, and questions related to claims coding for patients. The Coordinator will perform auditing of offshore coding for quality assurance and education. Collaboration with assigned client/RCM teams, providing education on coding denial trends and/or opportunities for coding improvement and documentation requirements. The Coordinator will also create presentations, develop learning material, and provide feedback to internal and external customers on denials and coding improvements.
**QUALIFICATIONS REQUIRED AND EXPERIENCE:**
* Master’s Degree preferred or BA or BS in Finance, Accounting or Finance, experience with Accounting and/or Finance and Healthcare Administration experience
* A minimum of 2 years of recent or previous Healthcare Administrative experience and one of the following: Certified Professional Coder (CPC), Certified Professional Coder-Hospital Outpatient (CPC-H), Certified Professional Biller (CPB™), Certified Professional Medical Auditor (CPMA®), and Certified Documentation Expert Outpatient (CDEO®).
* Optional practical training (OPT)
* Curricular Practical Training (CPT)
* Bilingual a plus; Haitian Creole, Portuguese Creole, Spanish, Vietnamese, Chinese, or Cambodian
**POSITION RESPONSIBILITIES AND TASKS:**
* Manages team of Documentation Specialist, Medical Billers and Coders
* Write all billing operations policies, procedures and protocols
* Assistant with hiring management, monitor and billing and coding teams for patient accounts
* This position is responsible for ensuring optimal billing and collections revenue by ensuring patient accounts are thoroughly analyzed to ensure successful payment, to ensure self-pay accounts are optimized for collections, and to reconcile co payment batches.
* Meets with team daily to provide training, monitoring, billing and coding implement and comply with company policies, procedures and protocols
* Analyze patient accounts, identify billing issues, and determine solutions with patients and insurance companies.
* Organize all internal and external funding billable accounts and identify all collection issues and assist in appropriate resolution.
* Monitor all claim activities and manage vendor invoicing and prepare appropriate financial reports.
* Experience and knowledge of healthcare and medical terminology, including but not limited to: CPT, ICD9 /ICD10 codes and use of modifiers
* Maintains Revenue Cycle knowledge in the following areas including PFS, Customer Service, Cash Posting, Financial Assistance, Patient Access, HIM/Coding and/or 3rd party Reimbursement.
* Monitors all authorizations activities, manages vendor authorizations, billing units, and prepares appropriate financial reports.
* Setups of Clearing house for Billing and coding
* Assisting in appeal hearings related to prior authorization denials.
* Prepares invoices for patients and insurance billing, submits and processes insurance claims.
* Coordinating billing for all programs (Private Pay, Third Party Billing, MassHealth, etc.)
* Prepare Patient Account reports to Accounts Receivable
* Processes Electronic Claims via Coding Specialist, Data Quality Analyst.
* Conducts prior authorization reviews and obtains extensions to continue services.
* Enters all review results in appropriate data systems and excel sheets as Claims Reviewer.
* Summary Reporting to the Director Revenue Cycle and Billing & Coding Manager, the Coding Coordinator provides coding and revenue cycle support to the Department of Emergency Medicine
* The Coding Coordinator is responsible for the review and resolution of all coding related pre-billing edits and/or rejections to ensure prompt and accurate reimbursement
* Initiates medical record reviews and recommends proper action.
* Communicates with direct care staff and medical staff and billing staff regarding missing or unclear documentation.
* This Coordinator will analyze and report trends with team members to report to Managers
* Responsibilities Reviews and resolves all assigned tasks and encounters associated with potential coding discrepancies as it relates to pre billing system edits and/or claims with outstanding balances
* Reviews and resolves any pre & post billing coding edits (TES) and resubmits claim for adjudication
* Ensures all services documented in patient charts are coded with appropriate diagnoses, CPT & HCPCS procedure codes Aims to reduce accounts receivable by reviewing claims rejected for coding; investigates assigned accounts to determine what additional steps must be taken for claims to be resolved
* Conducts one-on-one or small group education for direct care staff and medical staff regarding the results of their periodic audits while maintaining an exceptionally high level of professionalism Assists providers in developing effective Letters of Medical Necessity (LMN) and/or templates for appealing denials associated to complex procedures based on payer requirements and medical documentation
* Maintains a thorough working knowledge of all aspects of billing and collections including billing rules and regulations, collection practices, electronic billing processes, CMS 1500 Form requirements, diagnosis and CPT/HCPCS coding, and applicable county, state, and federal requirements
* Researches and responds to insurance coding requests; assist with claim issues, including preparing coding appeals
* Proactively elevates coding problems to the providers and maintains tracking reports when issues and trends have been identified
**Org Unit/Class Cag:**
* AFS1 Entry- and Intermediate level
**Maintenance & Quality Improvement:**
* Maintain daily billing for patient account payable and receivable
* Ensures all patient data entry is Coded with appropriate diagnoses, CPT & HCPCS procedure codes
* Provides staffing training on documentation for billing
* Submitting billing claims and resubmitting claims research for payment
* Maintain up date compliance on billing and coding
* Maintain tracking of patient authorizations units and billing tracking
**KEY SKILLS & BEHAVIOR:**
* Strong math, analyzing, interpersonal skills and Excellent time management skills
* Strong analytical skills and interpersonal skills willing to work directly with staff
* Ability to communicate effectively within a variety of situations and diverse populations
* Ability to work independently and as part of a team
* High attention to detail
**SALARY & BENEFITS:**
* $1000 per Month increase based on KIP monthly the hire after training
* $23-$30 per hour depending on experience
* Flexible Schedule
* Must however be willing to work some late afternoons and evenings until 8:15pm, and some weekends.
* Education stipends with partnering colleges available after one year of employment
* Possible H1B Visa sponsor After 365 days of hirer
**TO APPLY:**
Via our website Job Board to view available positions and submit your application.
Screening questions will need to answered after you will be asked to complete assessment and send
* Must be able to operate a motor vehicle and travel locally (as required by Plan)
