Summary:
Under the general direction of the Practice Manager, the Billing Specialist is responsible for monitoring HOPD departmental billing processes and makes corrections as needed. Manages the timely and accurate posting of physician charge data for both patient and client –billed accounts. Identifies, corrects, and maintains appropriate billing data within the HOPD systems. Resolves insurance claim errors and regulatory edits related to physician billing. Handles customer billing inquires.
CHRISTUS Santa Rosa Hospital - Westover Hills (CSRH-WH) is a 150-bed hospital serving the fastest growing area of San Antonio. Specialized care includes orthopedic and surgical services, ICU, women’s services, a newborn nursery, comprehensive cardiovascular care from diagnostics to open heart surgery, vascular lab, sleep center, emergency services, the CHRISTUS Weight Loss Institute, wound care, rehabilitation, and more. The campus also boasts an Outpatient Imaging Center and three medical plazas, one of which houses our CHRISTUS Santa Rosa Family Medicine Residency Program and CHRISTUS Santa Rosa Family Health Center.
Responsibilities:
- Researches, identifies and submits appropriate CDM coding/billing requests for the HOPD setting.
- Acts as the technical expert for the HOPD concerning HCPC/CPT code assignment for the CDM.
- Performs pre-submission audit of HOPD coding/documentation and monitoring of activities to ensure compliance billing and internal standards are met in accordance with national reimbursement agencies’ standards and regulations (Medicare/Medicaid).
- Maintains knowledge of all insurance/payer billing requirements for HOPD procedures.
- Identifies trends in billing issues and payer specific requirements.
- Maintains knowledge of the HOPD computer system and the electronic billing system and ensures that system features are used effectively to support billing activity.
- Audits and reconciles each HOPD to ensure all billable services/items are charged appropriately.
- Identifies opportunities to recoup and prevent potential future loss of billing revenue for the HOPD.
- Provides technical support to the hospital’s coding team to ensure accurate coding and billing of HOPD procedures.
- Performs other duties as assigned.
Requirements:
Education/Skills
- Highschool diploma or GED.
- Certified Coder preferred
- Computer literacy required, specifically in Microsoft Office.
- Must be proficient with spreadsheets and word processing applications.
- Working knowledge of financial accounting and billing procedures.
- Completion of Medical Terminology and anatomy/physiology courses, medical coding/billing certification, or related experience is required in order to classify procedure codes.
Experience
- Minimum four years extensive CPT and ICD9/10 CM coding experience required.
- Thorough knowledge of applying third party and government payor regulations required.
Licenses, Registrations, or Certifications
- Medical billing certification, preferred
- Medical coding certification, preferred
Work Schedule:
Varies
Work Type:
Full Time