Medical Billing, Coding and Denial Specialist (CareVue, Billing, Coding)

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 Responsibilities

Inpatient Coding

• Assign accurate and compliant ICD-10-CM diagnosis codes for inpatient encounters
• Assign accurate and compliant ICD-10-PCS procedure codes
• Review physician documentation for completeness and accuracy
• Identify complications and comorbidities (CC/MCC) to ensure appropriate DRG assignment
• Query physicians for documentation clarification when necessary to support accurate coding
• Ensure compliance with all applicable coding guidelines including Official Guidelines for Coding and Reporting

Outpatient Coding

• Assign accurate CPT/HCPCS codes for outpatient services
• Assign accurate ICD-10-CM diagnosis codes for outpatient encounters
• Perform APC assignment for outpatient services
• Code observation services in compliance with CMS guidelines
• Code emergency department encounters with appropriate E/M levels
• Code same-day surgery procedures
• Code outpatient diagnostic services (radiology, laboratory, cardiology, etc.)

Claims Preparation and Submission

• Review encounter/charge data for completeness prior to claim submission
• Prepare UB-04/837I institutional claims and CMS-1500/837P professional claims
• Validate all coding assignments and charges against documentation
• Validate critical data elements including:
  • Member/patient identification numbers
  • National Provider Identifier (NPI) numbers
  • Provider taxonomy codes
  • Procedure modifiers
  • Units of service
  • Attending and operating provider information
• Verify compliance with payer-specific rules and requirements
• Perform claims formatting and compliance checks
• Submit claims electronically through designated clearinghouse or billing system
• Ensure timely electronic submission of claims within 48-72 hours of receiving complete information
• Monitor claim acceptance or rejection status
• Correct and resubmit rejected claims within 48 hours of notification
• Maintain compliance with payer filing limits and timely filing deadlines
• Manage clearinghouse transactions and resolve transmission issues

Denial Management

• Review and analyze claim denials and rejections
• Identify root causes of denials (coding errors, documentation deficiencies, registration issues, etc.)
• Correct coding or billing errors and resubmit claims
• Prepare appeals with supporting documentation when appropriate
• Track denial trends and recommend process improvements
• Work collaboratively with clinical documentation improvement (CDI) staff to address documentation issues

Quality and Compliance

• Maintain 95% patient billing accuracy rate
• Ensure all coding and billing activities comply with:
  • CMS regulations and guidelines
  • Medicare and Medicaid billing requirements
  • NCCI edits and bundling rules
  • Payer-specific policies and guidelines
  • HIPAA Privacy and Security Rules
  • HITECH Act requirements
  • GMHA privacy and security policies
• Participate in coding audits and quality assurance reviews
• Stay current with coding updates, regulatory changes, and payer policy modifications
• Complete continuing education requirements to maintain certifications

Documentation and Communication

• Document all coding decisions, queries, and claim corrections
• Communicate effectively with physicians, clinical staff, and revenue cycle team members
• Provide coding education and guidance to clinical staff as needed
• Participate in team meetings and case reviews
• Maintain accurate records of work performed and productivity metrics

Required Qualifications

• Minimum 10 years of hospital medical billing and coding experience
• 5+ years of demonstrated experience in supervisory role of hospital setting highly desirable
• Extensive experience with Emergency Room (ER) medical billing and coding
• Required system experience with one or more of the following:
  • CareVue
  • VistA (Veterans Health Information Systems and Technology Architecture)
  • CPRS (Computerized Patient Record System)
• Familiarity with hospital billing systems and clearinghouses
• Electronic claims submission experience
• Active certification as CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) preferred
• Comprehensive knowledge of Medicare and Medicaid billing requirements
• Proficiency in ICD-10-CM diagnosis and procedure coding
• Proficiency in CPT/HCPCS coding
• Experience with UB-04/837I institutional claim formats & CMS-1500/837P professional claim formats
• Knowledge of APC (Ambulatory Payment Classification) assignment

Salary: $30/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 [email protected] with your request and contact information.