<p>Company Overview: Eau Claire Cooperative Health Center, Inc. (dba Cooperative Health) is a leading community health center serving the Midlands of South Carolina since 1981. It is deeply rooted in its mission of providing accessible, high quality, compassion health care in the spirit of the Good Samaritan. The organization's values of: treating each other with respect, putting people first, being excellent at what we do, promoting a collaborative work environment, improving community/population health, fostering innovative thinkers, and getting results, are core attributes of every employee at Cooperative Health.</p> <p>Job Summary</p> <p>The Revenue Cycle Specialist-Biller 3 will be assigned to a Practice Location with four or more Providers. The Revenue Cycle Specialist-Biller 3 is Responsible for increasing billing efficiency and profitability through daily Claim and Chart reviews for accuracy. Additional responsibilities will include, review of coding to identify the need for adjustments and/or corrections according to individual payer guidelines and other Billing duties and tasks as assigned by Revenue Cycle Supervisor and/or Revenue Cycle Director.</p> <p>Essential Job Functions</p> <ul> <li>Effectively communicates with providers and operations staff to clarify diagnosis, procedure coding and documentation requirements, including proper sequencing. </li><li>Reviews assigned ICD-10-CM codes, which most accurately describe each documented diagnosis and/ or procedure according to established ICD-10-CM, CPT and CDT coding guidelines along with modifier usage and medical terminology. </li><li>Monitors all coding accuracy at various levels of detail and maintains coding quality as needed. </li><li>Tracks coding issues and reviews coding inaccuracies to highlight areas of improvement. </li><li>Reports identified coding issues to Clinic Management, Revenue Cycle supervisor and Revenue Cycle Director. </li><li>Attends monthly site meetings in person and Team huddles via Zoom or Teams. </li><li>Performs Encounter review to assure documentation supports coding on Superbills. </li><li>Daily review of accounts to, identify the need for adjustments or guarantor responsibility. </li><li>Process Insurance adjustments as needed. </li><li>Verification and Reconciliation of Insurance payments for claims previously billed in error. </li><li>Review and prepare claims for submission to various insurance carriers. </li><li>Correct and resubmit denied claims (as needed). </li><li>Responsible for working assigned Biller 3 Claim Buckets. </li><li>Responsible for responding to emails and Athena text pertaining to claim corrections. </li><li>Responsible for to stay up to date on all medical coding changes and providing updates to the appropriate staff. </li><li>Responsible for identifying trends of up coding and under coding errors. </li><li>Responsible for review and charge entry of Hospital charges (as applicable) </li></ul> <p>.</p> <p>Education & Experience:</p> <ul> <li>Education -Bachelor's Degree or higher in related field. </li><li>Minimum 5 years Medical Billing, Collections and Insurance experience. </li><li>Must have Coding Certification and maintain annual CEU's (submit proof) </li><li>Formal Training or working knowledge of ICD-10 and CPT coding. </li><li>Current working knowledge of Medical software and knowledge of health insurance industry. </li></ul> <p>Competencies</p> <ul> <li>Ability to embody the mission and vision of Cooperative Health. </li><li>Excellent written and verbal communication and problem solving skills. </li><li>Ability to communicate with people from a variety of socioeconomic and cultural backgrounds. </li><li>Ability to prioritize, organize and carry out work assignments independently and efficiently. </li><li>Ability to maintain appropriate degree of confidentiality. </li><li>Proficient in use of computer programs including Word, Excel, PowerPoint </li></ul> <p>Physical demands</p> <ul> <li>Prolonged periods sitting or standing </li><li>Must be able to lift up to 25 pounds. </li><li>Be able to sit, stand, stoop, squat for extended periods of time throughout the day. </li><li>Standing or walking for extended periods throughout the day. </li></ul> <p>Company conformance statement</p> <p>In the performance of respective job assignments, all employees are required to conform with Cooperative Health's:</p> <ul> <li>Board approved policies and procedures; </li><li>Confidentiality and professional provisions; </li><li>Compliance program; and </li><li>Standards of conduct. </li></ul> <p>Cooperative Health provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Cooperative Health complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfers, leaves of absence, compensation and training.</p>