Medical Billing and Coding Analyst (Law Enforcement)

GUILFORD COUNTY GOVERNMENT

Description

GENERAL STATEMENT OF DUTIES

The Medical Billing and Coding Analyst is responsible for reviewing, auditing, and submitting medical billing claims to ensure compliance with federal, state, and payer-specific regulations.

DISTINGUISHING FEATURES OF THE CLASS

The Medical Billing and Coding Analyst is responsible for reviewing, auditing, and submitting medical billing claims to ensure compliance with federal, state, and payer-specific regulations. This position also ensures accurate CPT, HCPCS, and ICD-10 coding, resolves claim rejections and provides training to clinical and administrative staff regarding documentation and coding accuracy.

Examples of Duties

DUTIES AND RESPONSIBILITIES

Essential duties and responsibilities include, but are not limited to:

• Reviews and verifies clinical documentation and coding for accuracy and compliance with coding standards (CPT, ICD-10, HCPCS).
• Submit electronic and paper claims to Medicaid, Medicare, and third-party payers.
• Ensure all claims submitted meet the payer’s requirements.
• Review reimbursements and ensure proper code use from third-party payers to ensure payment through proper use of codes.
• Analyze denied and rejected claims, determine root causes, and perform corrections and resubmissions.
• Conduct internal audits of billing practices and documentation to identify and prevent compliance issues.
• Monitors Medicaid reimbursement and maintain files.
• Ensure information is available for peer and Medicaid review.
• Complete internal quality compliance reviews.
• Educate and train clinical and administrative staff on proper medical coding and documentation best practices and procedures.
• Maintain diagnosis code master files. Identify inappropriate codes and inform appropriate medical staff of changes.
• Create reports related to billing activity, productivity, denials and revenue for management and external reporting.
• Other duties as assigned.

RECRUITMENT STANDARDS

Knowledge, Skills, and Abilities

• Thorough knowledge of CPT, ICD-10, and HCPCS coding systems
• Knowledge of Medicaid, Medicare, and third-party payer billing requirements
• Proficient with computers and medical billing software.
• Basic knowledge of accounting principles.
• Strong analytical and problem-solving skills
• Ability to interpret medical records and clinical documentation
• Proficient skills in electronic health records (EHR) and billing software
• Excellent verbal and written communication skills
• Ability to perform repetitive or routine tasks following established procedures and applying clearly prescribed standard practices.
• Ability to use sound judgement when following coding, billing and medical protocols.

Typical Qualifications

MINIMUM QUALIFICATIONS

Associate’s degree and three years of experience in medical coding and billing, or high school degree and five years of experience in medical coding and billing.

Preferred

Associate’s degree and three years in medical billing and/or coding, AND certification in one of the following: Certified Professional Biller (CPB), Certified Professional Coder (CPC), Certified Professional Biller (CPB), Billing Coding Specialist Certification (BCSC), or Certified Reimbursement Specialist (CMRS).

Supplemental Information

Physical Demands

Work is sedentary. However, there may be some walking, standing, bending, carrying light items such as papers, books, etc. Also, there may be some occasional lifting and moving of boxes, reports, and files.

Working Conditions

• Environment: Work environment is in a normal office environment
• Hazards: Routine office hazards such as desk corners, cabinet drawers, cords, and chairs

May Require Driving

This position may require driving for this position whether driving a County owned or personal vehicle to conduct county business such as but not limited to attending conferences, meetings, or any other county related functions. Motor Vehicle Reports may be verified for valid driver’s license and that the driving record is compatible with the county’s driving criteria.

If a personal vehicle is operated for county business proper insurance is maintained as per Guilford County’s vehicle use policy.

Special Note: This generic class description gives an overview of the job class, its job functions and recommended job requirements. However, for each individual position assigned to this class, there is available a completed job description with physical abilities checklist which can give further details about that one specific position. Those documents should be reviewed before initiating a selection process. They can provide additional detailed information on which to base various personnel actions and can assist management in making legal and defensible personnel decisions.

Guilford County is committed to providing Equal Employment Opportunity (EEO) to employees and applicants for employment regardless of color, religion, sex, na…