MicroHealth is seeking an experienced Medical Billing, Coding and Denial Specialist with CareVue (or similar EHR) experience to provide hospital medical billing and coding support services. This position will ensure accurate clinical coding and timely preparation and submission of hospital medical billing claims for both inpatient and outpatient hospital services. The specialist will operate as an extension of customer's current medical billing and coding team, working remotely based on operational needs. Incumbent will work rotating shift.Essential Duties and ResponsibilitiesInpatient CodingAssign accurate and compliant ICD-10-CM diagnosis codes for inpatient encountersAssign accurate and compliant ICD-10-PCS procedure codesReview physician documentation for completeness and accuracyIdentify complications and comorbidities (CC/MCC) to ensure appropriate DRG assignmentQuery physicians for documentation clarification when necessary to support accurate codingEnsure compliance with all applicable coding guidelines including Official Guidelines for Coding and ReportingOutpatient CodingAssign accurate CPT/HCPCS codes for outpatient servicesAssign accurate ICD-10-CM diagnosis codes for outpatient encountersPerform APC assignment for outpatient servicesCode observation services in compliance with CMS guidelinesCode emergency department encounters with appropriate E/M levelsCode same-day surgery proceduresCode outpatient diagnostic services (radiology, laboratory, cardiology, etc.)Claims Preparation and SubmissionReview encounter/charge data for completeness prior to claim submissionPrepare UB-04/837I institutional claims and CMS-1500/837P professional claimsValidate all coding assignments and charges against documentationValidate critical data elements including:Member/patient identification numbersNational Provider Identifier (NPI) numbersProvider taxonomy codesProcedure modifiersUnits of serviceAttending and operating provider informationVerify compliance with payer-specific rules and requirementsPerform claims formatting and compliance checksSubmit claims electronically through designated clearinghouse or billing systemEnsure timely electronic submission of claims within 48-72 hours of receiving complete informationMonitor claim acceptance or rejection statusCorrect and resubmit rejected claims within 48 hours of notificationMaintain compliance with payer filing limits and timely filing deadlinesManage clearinghouse transactions and resolve transmission issuesDenial ManagementReview and analyze claim denials and rejectionsIdentify root causes of denials (coding errors, documentation deficiencies, registration issues, etc.)Correct coding or billing errors and resubmit claimsPrepare appeals with supporting documentation when appropriateTrack denial trends and recommend process improvementsWork collaboratively with clinical documentation improvement (CDI) staff to address documentation issuesQuality and ComplianceMaintain 95% patient billing accuracy rateEnsure all coding and billing activities comply with:CMS regulations and guidelinesMedicare and Medicaid billing requirementsNCCI edits and bundling rulesPayer-specific policies and guidelinesHIPAA Privacy and Security RulesHITECH Act requirementsGMHA privacy and security policiesParticipate in coding audits and quality assurance reviewsStay current with coding updates, regulatory changes, and payer policy modificationsComplete continuing education requirements to maintain certificationsDocumentation and CommunicationDocument all coding decisions, queries, and claim correctionsCommunicate effectively with physicians, clinical staff, and revenue cycle team membersProvide coding education and guidance to clinical staff as neededParticipate in team meetings and case reviewsMaintain accurate records of work performed and productivity metricsRequired QualificationsMinimum 10 years of hospital medical billing and coding experience5+ years of demonstrated experience in supervisory role of hospital setting highly desirableExtensive experience with Emergency Room (ER) medical billing and codingRequired system experience with one or more of the following:CareVueVistA (Veterans Health Information Systems and Technology Architecture)CPRS (Computerized Patient Record System)Familiarity with hospital billing systems and clearinghousesElectronic claims submission experienceActive certification as CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) preferredComprehensive knowledge of Medicare and Medicaid billing requirementsProficiency in ICD-10-CM diagnosis and procedure codingProficiency in CPT/HCPCS codingExperience with UB-04/837I institutional claim formats & CMS-1500/837P professional claim formatsKnowledge of APC (Ambulatory Payment Classification) assignmentSalary: $30-35/hr (Commensurate with experience)Physical Demands:While performing the duties of this job, the employee is regularly required to sit. The employee frequently is required to walk; use hands to finger, handle or feel; reach with hands and arms; and talk or hear. The employee is occasionally required to stand. The employee may lift or move objects up to 5 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, and the ability to adjust focus.MicroHealth will recruit, hire, train, and promote persons in all job titles, and ensure that all other personnel actions are administered without regard to race, color, religion, sex, sexual orientation, gender identity, genetic information, national origin, disability, or status as a protected veteran and ensure that all employment decisions are based only on valid job requirements.All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.If you need reasonable accommodation due to a disability for any part of the employment process, please send an e-mail to hr@microhealthllc.com with your request and contact information.
