Medical Billing and Coding Specialist

• Primary point of contact for claim submissions, scrubbing and reconciliation of denials.
• Collects, codes, and transmits patient medical information to collect Medicaid and Child Health Plan Plus (CHP+) reimbursements and other insurance plans or third-party vendors.
• Creates billing policies and procedures that align with Adams County Public Health standards of service delivery.
• Processes patient invoices, statements, collections, billing and write off processes as per all HIPAA guidelines, grant deliverable requirements, TITLE X requirements and any regulatory guidelines or requirements that may apply.
• Audits and resolves discrepant bills, ensures accurate charges and appropriate codes and modifiers are assigned, scrubs claims, and reconciles EOBs, payments and statements sent to patients.
• Monitors accounts receivable and aging and ensures payments are posted to general ledger.
• Identify and analyze coding and billing concerns raised by internal and external stakeholders.

• Serves as liaison with insurance providers to maintain most current fee schedules.
• Provide updates to Nursing Informatics to maintain current CPT, ICD-10 reimbursement in Electronic Medical Record.
• Maintains current fee schedule.
• Ensure appropriate and timely coding of encounters.
• Conducts quarterly chart audits.
• Maintains all provider credentialing related to billing, including maintaining accuracy of codes and rates to ensure accurate quotes at time of service.
• Responsible for optimization of payments and workflows, analyzing the codes and making suggestions on streamlining modifier usage.
• Provides programs with notification of denials and claim status.
• Creates and maintains process to gain corrections within programs and resubmit claims.
• Reports trends, collection efforts and revenue by payer for budgeting purposes.
• Assists with the following: preparing bank deposits, running reports, completing pre-authorizations and eligibility checks.
• Perform other related duties and responsibilities as required.

• Requires a strong understanding of State, Federal and commercial health insurance coverage.
• Requires a strong understanding of medical coding using ICD 10, CPT, HCPCS, and modifiers.
• Requires a strong understanding of AR and Aging Analysis.
• Requires a strong understanding of Revenue Cycle Management.
• Must be able to maintain HIPAA client confidentiality and protect the privacy of client information.
• Strong attention to detail and accuracy.
• Strong communication skills, both verbal and written.
• Strong computer skills, specifically with billing and electronic health record systems.
• Utilize various computer programs.
• Willingness to learn new systems and procedures.
• Self-motivated organizational skills, with the ability to follow a priority structure.
• Exceptional written and verbal communication skills.
• Thrive in a hybrid work environment as part of a team and independently.
• Excellent organizational skills; strong attention to detail and follow-through.
• Project management-type skills; prior experience managing a high-volume workload.
• Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.
• Proactively identify opportunities to streamline coding and billing processes and enhance revenue cycle efficiency.

• High School diploma or equivalent is required.
• Three years medical billing and medical coding experience.
• At least one year experience in customer service.
• Possession of a Medical Coder OR Medical Billing certification from a credentialing organization such as but not limited to the American Health Information Management Association (AHIMA), American Academy of Professional Coders (AAPC), OR Practice Management Institute (PMI), will substitute for 2 years of medical billing & coding experience.

• Associate Degree in Health Information or in healthcare related field.
• Registered Health Information Technician (RHIT), OR Certified Coding Specialist (CCS) credential through American Health Information Management Association (AHIMA).
• Medical coding certification.
• Experience working with Medicaid, Medicare, and commercial insurances.
• Experience in a medical clinic or public health environment.
• Experience with electronic health record software and proficiency in using Microsoft office products.

• Spends 90% of the time sitting and 10% of the time either standing or walking.
• Occasionally lifts, carries, pulls, or pushes up to 20 lbs.
• Occasionally uses cart, dolly, or other equipment to carry in excess of 20 lbs.
• Occasionally climbs, stoops, kneels, balances, reaches, crawls and crouches while performing office or work duties.
• Verbal and auditory capacity enabling constant interpersonal communication through automated devices, such as telephones, radios, and similar; and in public meetings and personal interactions.
• Constant use of eye, hand and finger coordination enabling the use of automated office machinery or equipment.
• Visual capacity enabling constant use of computer or other work-related equipment.

• AFLAC Supplemental Medical Insurance
• Basic Term Life & Optional Term Life Insurance
• Deferred Compensation Plan
• Dental/Vision/Medical Plans
• Generous Vacation/Sick leave
• Long-Term Disability
• Retirement Plan
• Short-Term Disability

• Employee Assistance Program
• Employee Fitness Center
• Employee Health Clinics
• Flexible Work Schedules
• Recreation Center Discounts
• Training & Tuition Reimbursement Programs
• Wellness programs
• Lactation friendly certified workplace

Adams County