Billing and Coding Coordinator

 

POSITION SUMMARY

The Billing and Coding Coordinator is responsible for the implementation of internal billing and coding processes to ensure effective claims billing and revenue capture.  

 

POSITION OBJECTIVES 

Integral to our team, the Billing and Coding Coordinator will implement and improve billing processes for claims-based payment.  This includes billing for contracted insurance partners, non-contracted insurers, Medicare, and Medicaid.  Contracted insurance partners could include plans with commercial, Medicare Advantage, and Medicaid Managed Care enrollees.

UCM is a rapidly growing company and the Billing and Coding Coordinator will be responsible for improving UCM’s billing platforms, connecting them to payers, and shepherding claims through the revenue cycle.

The Billing and Coding Coordinator will implement billing processes that focus on continuous and measurable improvement of revenue capture.  This team member needs to be adept at directly managing coding, billing, claims tracking, fast-paced troubleshooting, and revenue reporting.  This role will be dynamic and evolving in nature as the business scales and requires a person with excellent analytical skills, an innovative mindset, and energy for thriving in a high growth environment.

 

SUMMARY OF RESPONSIBILITIES AND DUTIES

  • Coordinate the billing interactions between UCM, UCM’s billing vendor, and health insurance/managed care plans to maximize revenue collection. 
  •  Implementing, managing, and consistently improving Medicaid and Medicare fee-for-service billing.  (example: Community-based organizations, Medicare ET3, and developmental disability clients)
  • Facilitate billing of non-contracted insurers to enable UCM services to be made available on the broadest possible basis through local governments, 911, and EMS.  
  • Serve as a resource to and facilitator of the development of billing information collection systems, data tracking and reporting, and billing quality improvement.  
  • Define coding standards, U&C standards, and payer and contract-specific coding conventions and exceptions.
  • Follow-up on claims exceptions and issues that have been escalated from billing vendor.  
  • Facilitate immediate problem solving to ensure claims are paid in a timely manner and denials management to correct/resubmit/appeal when necessary.
  • Manage and report metrics, KPIs, and statistical performance related to billing.  Monitor accounts receivable and billing activity for non-payment.
  • Assume liaison responsibilities with billing vendor. 
  • Actively participate in the digital redesign of billing systems and serve as the hub for increasing their efficiency.
  • Work closely with operations department to smoothly integrate billing processes with provider and care coordinator workflow.
  • Work closely with the provider credentialing department.
  • Maintain compliance by adhering to government regulations and coding guidelines.
  • Adhere to all corporate Information Security policies and procedures.  Identify any breaches or potential breaches of corporate Information Security standards and communicate those to appropriate individuals.  Maintain integrity, availability, and confidentiality of all PHI. Adhere to HIPAA standards for information security, privacy, and confidentiality.
  • Maintain an effective working and interpersonal relationship with the medical personnel, administrative personnel, and clients to achieve maximum billing effectiveness.
  • Other duties as assigned.

 

EDUCATION AND EXPERIENCE

Education: Bachelor’s Degree or equivalent education and experience.  Medical coding certification.

Experience:  Five years of medical billing experience with progressively increasing responsibility, including managing a billing team and overseeing medical practice coding and insurance billing in a multi-payer environment. Clear understanding of claims processing, as well as rules of multiple insurance companies.

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