| Summary: Responsible for assigning appropriate CPT and ICD-9 codes to inpatient and outpatient hospital services along with services rendered in skilled nursing facilities by wound care providers. Excellent interpersonal skills required in order to communicate and train providers and other staff members regarding coding requirements.
Essential Duties and Responsibilities
- Responsible for translating healthcare providers’ diagnostic and procedural phrases into coded form.
- Obtain any necessary clarification of information on the notes and charts from provider
- Enter and organize the codes into management software
- Prepare the appropriate claims documents required by each insurer
- Prepare monthly summary of claims requiring clarification and analyze for possible trends
- Provide coding training to providers and other staff
- Ability to identify missing or incomplete medical records.
- Participate in completion of special projects as assigned by management.
- Generate Excel spreadsheets for special projects as assigned.
- The ability to manage multiple responsibilities as assigned.
- Must have the ability to interact with all levels of management.
- Communicate with supervisor and\or manager about the status of assigned projects.
- Maintaining professionalism, customer service and a courteous demeanor at all times
Qualifications:High school graduate or equivalent, Associates degree through accredited college preferred, 3-4 years of coding experience in physician office/ hospital, successful completion of coding certification, with current CEU’s, Specialty E&M preferred, proficient in data entry/10 key, proficient with practice management software.
- Change Management
- Work Standards
The incumbent in the position will not supervise other employees.
High school diploma or general education degree (GED), Associates degree preferred. 3-4 years related experience and training; or equivalent combination of education and experience. 1-2 years of physician/hospital office experience.
Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to understand medical terminology in order to communicate with physicians. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
- Language Ability:
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
- Math Ability:
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
- Reasoning Ability:
Must be able to use Microsoft Outlook, Word, and Excel, as well as web-based database programs, practice management software and the Internet.
- Computer Skills:
The incumbent in this position is not required to work under any extreme conditions, and must be able to work around a moderate noise level, such as an office environment.
- Work Environment:
Medical Billing Specialist is accountable for day to day operations of making sure that all assigned tasks are completed in a timely manner; in addition to maintaining the goals and objectives of the billing department and organization.
Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.
Analysis/Assessment - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Researches and finds relevant information and identifies key issues and relationships from a base of information; compiling data from a variety of sources and identifying cause-and-effect relationships; Demonstrates attention to detail.
Attention to Detail – Performs tasks while focusing on all aspects of the task no matter how small; Checks all processes and tasks for accuracy; demonstrates vigilance in assuring completeness and accuracy of all work.
Attendance/Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.
Business Acumen - Understands business implications of decisions; Displays orientation to profitability: Demonstrates knowledge of market and competition: Aligns work with strategic goals.
Change Management - Develops workable implementation plans; Communicates changes effectively; Builds commitment and overcomes resistance; Prepares and supports those affected by change; Monitors transition and evaluates results.
Cost Consciousness - Works within approved budget; Develops and implements cost saving measures; Contributes to profits and revenue; Conserves organizational resources.
Customer Service - Manages difficult or emotional customer situations; Solicits customer feedback to improve service; anticipates and provides solutions to meet customer needs, giving high priority to customer satisfaction; Responds to requests for service and assistance; Meets commitments.
Delegation - Delegates work assignments and decision-making authority; Matches the responsibility to the person; Gives authority to work independently; Sets expectations and monitors delegated activities; Provides recognition for results.
Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.
Creative Thinking - Taking a new or unique approach to how work is performed; Generates and maintains a creative and change-oriented environment among or with staff or colleagues which leads to coming up with ideas; Looks beyond the facts and thinks outside the box or across or beyond traditional boundaries in order to recommend solutions, products or options for improvements that have not been used in the organization before.
Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; educates others on the value of diversity; promotes a harassment-free environment; Builds a diverse workforce.
Ethics - Treats people with respect; Keeps commitments; inspires the trust of others; Works with integrity and ethically; Upholds organizational values.
Initiative - Volunteers readily; Being proactive; Undertakes self-development activities; Seeks increased responsibilities; Takes independent actions and calculated risks; Looks for and takes advantage of opportunities; Asks for and offers help when needed.
Innovation - Displays original thinking and creativity; Meets challenges with resourcefulness; Generates suggestions for improving work; Develops innovative approaches and ideas; Presents ideas and information in a manner that gets others' attention.
Interpersonal Skills- Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.
Judgment - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.
Leadership – Ability to influence others such that they can be guided towards a planned direction; Using appropriate, multiple interpersonal styles to inspire and move others down a path to achieving a goal.
Managing People - Includes staff in planning, decision-making, facilitating and process improvement; Takes responsibility for subordinates' activities; Makes self available to staff; Provides regular performance feedback; Develops subordinates' skills and encourages growth; Solicits and applies customer feedback (internal and external); Fosters quality focus in others; Improves processes, products and services; Continually works to improve supervisory skills.
Motivation - Sets and achieves challenging goals; Demonstrates persistence and overcomes obstacles; Measures self against standard of excellence; Takes calculated risks to accomplish goals.
Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
Organizational Support - Follows policies and procedures; Completes administrative tasks correctly and on time; supports organization's goals and values; Benefits organization through outside activities.
Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives; Organizes or schedules other people and their tasks; Develops realistic action plans.
Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in-group problem solving situations; Uses reason even when dealing with emotional topics.
Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
Project Management - Develops project plans; Coordinates projects; Communicates changes and progress; Completes projects on time and budget; Manages project team activities.
Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.
Continuous Improvement - The commitment to think about the many processes and systems used to accomplish work and to recommend new ideas and suggestions that will improve the current work processes and procedures; The ideas and suggestions are self-initiated and involves seeking out and understanding tools, techniques and approaches that may or may not be currently applied in a work process or procedure.
Work Standards - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly.
Safety and Security - Observes safety and security procedures; Determines appropriate action beyond guidelines; Reports potentially unsafe conditions; Uses equipment and materials properly.
Strategic Thinking - Develops strategies to achieve organizational goals; Understands organization's strengths & weaknesses; Analyzes market and competition; Identifies external threats and opportunities; Adapts strategy to changing conditions.
Team Work - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Works effectively with team or group outside the formal lines of authority; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed; Recognizes accomplishments of other team members.
Functional/Technical Proficiency- Assesses own strengths and weaknesses; pursues training and development opportunities; Strives to continuously build knowledge and skills; Shares expertise with others.
Visionary Leadership - Displays passion and optimism; Inspires respect and trust; Creates a desired future state through helping others see, and emotionally feel, how things can be better.
Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.
Communication –Written, verbal or non-verbal means of expressing ideas effectively including adjusting language, terminology or the organization of concepts to the characteristics and needs of the audience.
Budget Process Proficiency – Thoroughly knowledgeable in the organization’s process and schedule; Anticipates and solicits input from staff regarding required expenditures for department operations; Demonstrates resourcefulness and discipline in working within approved fiscal framework while completing required objectives.
Coaching – Teaches knowledge and skills while encouraging and motivating an individual or team to accomplish a task or goal; Gives specific positive or mixed feedback for developmental purposes; Reassures others after a setback. Gives negative feedback in behavioral rather than personal terms, and expresses positive expectations for future performance and/or gives suggestions for improvement.
Continuous Learning - The commitment to think about the ongoing and changing needs of the organization and to learn how new and different solutions can be utilized to ensure ongoing business success; The learning is self-initiated and involves seeking out and understanding tools, techniques and approaches that may or may not be currently applied in one or many areas of expertise that could contribute to personal growth and the ongoing success of the individual and/ or the organization.
Developing Others - Involves active participation in the long-term learning or development of others with an appropriate level of needs analysis and other thought or assessment. Its focus is on the growth of the individual rather than on a specific topic of training; Approaches may include shadowing, mentoring, training, on-the-job training, projects and structured feedback processes.
Flexibility - To adapt quickly to people and circumstances; to respond quickly to emerging opportunities and risks; to acquire new/more effective behaviors as context and roles change.
Integrity/Honesty: Recognizes when being faced with making a decision or exhibiting behavior that may break with commonly held personal or social values; understands the effects of violating these beliefs and codes on an organization, oneself, and others; and chooses an ethical course of action.
High Energy – Sustains a high level of activity and productivity on a consistent basis.
Follow-Up – Methodology designed to monitor the results, of delegations, assignments, or projects; continuing to come back and review the progress of an individual or team assigned a task or project.
Meeting Facilitation – organizing information and using leadership behaviors to guide participants toward a meeting’s objectives, the use of situational behavior based on the tasks, situations, and participant behavior profiles.
Negotiation – The open exchange of positions and alternatives to reach an outcome that is satisfactory to all parties involved.
Peak Performance – Consistently exceeds performance expectations compared against established performance goals, established organizational values for the completion of work and feedback received from colleagues.
Persuasiveness/Sales Ability –Effectively uses relationship building and communication behaviors in order to convince a prospect or client of an idea, plan, activity, service, or product.
Specific Individual Considerations:
The designation of "essential functions" and "other duties" is for purposes of compliance with the
Americans with Disabilities Act. This job description should not be construed to imply that these requirements are the only duties, responsibilities, and qualifications for this position. Incumbents may be required to follow any additional related instructions, acquired related job skills, and perform other related work as required. Incumbents in this position may be required to perform all or some of the above duties and responsibilities with varying levels of concentration based on the incumbents skill level and departments’ needs.