Billing

The OB/GYN Coder and Biller (CB) is responsible for all aspects of billing and claims management (charge entry, payment posting, resolve denials, follow up as needed) for supporting providers when the OB/GYN department to ensure timely, accurate billing of health services rendered for insured and uninsured. 

The CB extracts all necessary information and evaluates assigned codes (ICD-10, CPT and HCPCS) to ensure coding most accurately describes each documented diagnosis and procedure stated by the physician or other health care providers are valid and complete in accordance with established guidelines. 

Quantitative analysis – Performs a comprehensive review of the record to assure the presence of all component parts such as: patient and record identification, signatures and dates where required, and other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered. 

 Qualitative analysis – Evaluates the record for documentation consistency and to adequacy ensure the final diagnosis accurately reflects the care and treatment rendered. Reviews the records for compliance with established third-party reimbursement agencies, special screening criteria, sliding scale, and self-pay. The Coder will also analyze provider documentation to ensure the appropriate Evaluation & Management (E & M) levels are assigned using the correct CPT code. 

Insurance Enrollment Support - Healthcare providers who wish to bill an insurance company and receive reimbursement for services must complete applications and necessary paperwork with chosen payor networks and government entities (i.e., Medicaid and Medicare). The CB completes applications with third-party billing company and/or directly with insurance companies, as appropriate. The CB maintains an up-to-date database listing each healthcare provider’s status of insurance enrollment including the effective date the healthcare provider was approved by insurance company. 

Essential Functions 

1. Audit clinical documentation, code surgical/outpatient encounters, manage claim denials, and oversee global OB billingPerform ICD-10, CPT and HCPCS coding for reimbursement by acting as the primary source for data and information and the ability to optimize reimbursement. 
2. Review, analyzes, and code diagnostic and procedural information that determines the appropriate and complete documentation to support billing of healthcare services rendered.
3. Maintains an up-to-date database listing each healthcare provider’s status of insurance enrollment including the effective date the healthcare provider was approved by insurance company. 
4. Verify all appropriate supporting documentation are obtained prior to submitting a clean claim. 
5. Assess reimbursement for individual supplies to ensure maximum reimbursement. 
6. Research and follow up on all correspondence associated with assigned accounts, including EOB’s and documentation letters, and generate correspondence requesting required information, when necessary. 
7. Post payments and / or adjustments to individual accounts. Analyze and correct accounts receivable problems. 
8. Initiate appeals and ensures all required documentation are submitted timely in the appeals process. Research all denials and follow ups. 
9. Receive inbound and place outbound calls to/from insurance companies and patients to collect outstanding funds. 
10. Ensure compliance with established coding guidelines, third party reimbursement policies, regulations, and accreditation guidelines. 
11. Perform other duties and responsibilities as assigned. 

Qualifications, Education, and Experience 

1. Certified Professional Coder (CPC) or Certified OB/GYN Coder (COBGC); Minimum 4 years specialty coding experience.
2. Advanced knowledge of medical codes involving selection of most accurate and descriptive code using CPT codes for billing of third-party resources.
3. Extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA), American Dental Association (ADA) and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes. 
4. Advanced knowledge of healthcare services terminology, abbreviations, anatomy, and physiology; major disease processes, to identify specific clinical findings to support existing diagnoses or substantiate listing additional diagnoses in the medical record. 
5. Knowledge and understanding of the billing and claim management process including denials, rejections, and appeals.
6. Knowledge and understanding of the insurance enrollment process. 
7. Skills in correlating generalized observations/symptoms (vital signs, lab results, medications, etc.) to a stated diagnosis to recommend assignment of the correct ICD-10-CM code. 
8.  Ability to organize and prioritize work and manage multiple priorities. 
9. Excellent verbal and written communication skills, including letters, memos, and emails.  
10. Excellent attention to detail.  
11. Ability to research and analyze data.  Ability to work independently with minimal supervision.  
12. Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.  
13. High school diploma or equivalent.  Associate degree preferred. 
14. Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.