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Billings Clinic Claims Specialty Coder II - CBO in Billings, Montana

You’ll want to join Billings Clinic for our outstanding quality of care, exciting environment, interesting cases from a vast geography, advanced technology and educational opportunities. We are in the top 1% of hospitals internationally for receiving Magnet® Recognition consecutively since 2006.

And you’ll want to stay at Billings Clinic for the amazing teamwork, caring atmosphere, and a culture that values kindness, safety and courage. This is an incredible place to learn and grow. Billings, Montana, is a friendly, college community in the Rocky Mountains with great schools and abundant family activities. Amazing outdoor recreation is just minutes from home. Four seasons of sunshine!

You can make a difference here.

About Us

Billings Clinic is a community-owned, not-for-profit, Physician-led health system based in Billings with more than 4,700 employees, including over 550 physicians and non-physician providers. Our integrated organization consists of a multi-specialty group practice and a 304-bed hospital.Learn more (https://www.billingsclinic.com/about-us/) about Billings Clinic (our organization, history, mission, leadership and regional locations) and how we are recognized nationally for our exceptional quality.

Your Benefits

We provide a comprehensive and competitive benefits package to all full-time employees (minimum of 24 hours/week), including Medical, Dental, Vision, 403(b) Retirement Plan with employer matching, Defined Contribution Pension Plan, Paid Time Off, employee wellness program, and much more.Click here (https://www.billingsclinic.com/careers/employee-benefits/) for more information ordownload the Employee Benefits Guide (https://ncstoragemlbillings.blob.core.windows.net/public/2021%20Billings%20Clinic%20Staff%20Benefits%20Guide.pdf) .

Magnet: Commitment to Nursing Excellence

Billings Clinic is proud to be recognized for nursing excellence as a Magnet®-designated organization, joining only 97 other organizations worldwide that have achieved this honor four times. The re-designation process happens every four years. Click here (https://www.billingsclinic.com/campaign-landing-pages/magnet/) to learn more!

Pre-Employment Requirements

All new employees must complete several pre-employment requirements prior to starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more!

Claims Specialty Coder II - CBO

CENTRAL BILLING OFFICE - 8861 (Billings Clinic Main Campus)

req3649

Shift: Day

Employment Status: Full-Time (.75 or greater)

Hours per Pay Period: 1.00 = 80 hours (Non-Exempt)

Starting Wage DOE: $23.29 - $27.37

Responsible for researching and analyzing coding related pre-bill scrubber edits , denials, and requests for review from Patient Financial services , and ensuring proper coding in compliance with government and third party payer regulations and CPT-4 , ICD, and HCPCs guidelines. Responsible to appeal denials and follow up with payers until the denied claims are paid. Collaborates with multiple departments and participates in review of Recovery Audit Contractor and other government audits and appeals. Provides reports to CBO contacts for trending and research and clarification of coding (ICD, CPT-4/HCPCS) and abstracting of diseases and surgical procedures. Provides education to the CBO teams based on findings .Ensures adherence to all applicable Billings Clinic Central Business Office and regulatory compliance policies and procedures governing medical records coding, insurance billing and reimbursement methodologies

Essential Job Functions

• Researches, analyzes, and appeals government and third party payer coding related denials of service based on explanation of benefits and remittance advice information and/or patient requests. Identifies trends/patterns that could pose a compliance risk or reimbursement issue and reports them to CBO Coding Management and CBO Coding Advisor for coding and documentation education, trending, and monitoring.

• Researches, analyzes, and resolves government and third party payer coding related per-bill scrubber edits.

• Identifies and reports any regulatory or compliance concerns to Coding Resources Manager.

• Monitors coding related audit activity in the organization’s tracking tool. Works in conjunction with the Clinical Coding Specialist and Coding Advisors to review of all coding related external audits determinations. Apply clinical and coding assessment skills to medical record, and extract supportive documentation for appeals. Report any issues to the department managers and compliance team. Provide clinical documentation education to appropriate staff and physicians. Communicate with outside agencies when necessary to clarify issues.

• Identifies needs and sets goals for own growth and development; meets all mandatory organizational and departmental requirements

Knowledge of:

• Coding and Compliance Auditing and regulations.

• Healthcare information management

• Medical terminology

• Anatomy and physiology

• Federal and third party payer regulations for institutional and professional claims.

• Practice management

• Third party insurance billing requirements & regulations, collection functions and reimbursement methodologies for institutional and professional claims

• Professional communication skills, both verbal and written

• Understanding the interaction between multiple software systems

• Analytical and critical thinking to assist with problem avoidance/resolution and process improvement

• Time management, organization, and prioritization

• Basic typing

• Information technology and project management

• Utilization of personal computers, hardware and software applications (i.e., word processing, spreadsheets, statistical analysis and graphics) and understanding the interaction between multiple midrange and high-range and software systems

• Process accurate and credible reports

• Utilization of performance and process improvement techniques

• Analytical and critical thinking

• DRG, ICD-CM, ICD PCS, CPT-4/HCPCS coding methodologies

• Analyze information from the patient’s medical record

• Research and analyze insurance claim remittance and correspondence according to defined procedures

Minimum Qualifications

Education

• High School diploma or GED

Experience

• Minimum Two years experience in a multi-specialty clinic and/or hospital working with ICD-CM, CPT-4, HCPCS, DRG coding

• Previous demonstrated experience in a clinical setting performing technical responsibilities related to ICD-CM, CPT-4/HCPCS, DRG coding, fees and reimbursement

• Demonstrated ability to understand and develop information using databases and creating complex spreadsheets. Intermediate knowledge of Microsoft Office products, including Word, Excel and PowerPoint.

• Prior training in anatomy, medical terminology and coding

Certifications and Licenses

• Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA), Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) or other AHIMA or AAPC recognized credentials required.

Billings Clinic is Montana’s largest health system serving Montana, Wyoming and the western Dakotas. A not-for-profit organization led by a physician CEO, the health system is governed by a board of community members, nurses and physicians. Billings Clinic includes an integrated multi-specialty group practice, tertiary care hospital and trauma center, based in Billings, Montana. Learn more atwww.billingsclinic.com/aboutus (https://www.billingsclinic.com/about-us/)

Billings Clinic is committed to the principles of Equal Employment Opportunity. All policies and processes are designed toward achieving fair and equitable treatment of all employees and job applicants. Employees are encouraged to discuss any concerns they have in this regard with their immediate supervisor and/or the Vice President People Resources. All employees and job applicants will be provided the same treatment in all aspects of the employment relationship, regardless of race, color, creed, religion, national origin, gender, gender identity, sexual orientation, age, marital status, genetic information or disability.

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