Provider Billing and Compliance Specialist

  • FirstHealth of the Carolinas
  • FirstHealth of the Carolinas - Corporate Pinehurst North Carolina US
  • Posted: Apr 11, 2019
Other Professional

Job Description

Working within Practice Management Operations, accesses multiple systems to identify and compile data supporting all types of billing and compliance scenarios. Recognizes trends or changes in risk areas, documentation and/or behaviors that may indicate potential violations in provider billing, competency and compliance. Identifies patterns and trends detrimental to revenue production, reports and corrects as directed or assists in the correction. Promotes provider and clinical staff production patterns and workflow through use of AMA and CMS guidelines and standards to facilitate change.  Serves as a behind the scenes "help desk" resource for billing and/or coding questions and issues directly related to multi-specialty provider billing. Examples include but are not limited to Behavioral, IDS, Transitional Care, Cardiology, Pain Management, Cardiovascular & Thoracic Surgery, Inpatient billing (Hospitalist), Primary care, School based, etc. to augment revenue and compliance.Competently navigates Star, Portal and Athena to achieve maximum application benefit and communicates the information as needed or required to various outpatient practice (clinic) billing staff and regional managers/directors. Assists Administration in adapting provider billing policies and flow process to achieve maximum efficiency, accuracy and outcome. Assists in the ongoing evaluation and correction of operational actions, both systems and staff oriented, that create an increase in denials or delayed billing, working closely with Practice Management Director of A/R and Business Development. Is alert to and assists with the correction of events like delayed credentialing, claim co-mingling and changes in unpostables that create revenue delay.Works with all clinic staff on the Athena billing system to enhance their knowledge and effectiveness in working claim edits, denials, collections, and self-pay as relative to compliance and or credentialing issues. Assists Athena Systems Database Administrator with billing questions and compliance issues.Provides back-up support to the Athena Systems Database Administrative role when necessary; remains cross-trained to A/R and Clinicals.Utilizes training to evaluate accounts for specific issues that breach compliance such as TCM, Medicare Annual Wellness, etc. Support the design and development of additional clinics and programs such as PCMH in conjunction with the goals and values of FH and under the guidance of administration. Works with Practice Management Administration of clinic A/R to initiate and or assist with identification of knowledge deficits, trends, compliance issues, etc. that impact global A/R's associated with Athena billing and documentation.

Two year associate degree in office technology; BS or BA in Healthcare Management preferred Minimum five (5) years' experience in a clinic setting that does both clinic and hospital billing.  Regulatory and compliance operational experience required.  Certified Professional Coder (AAPC) with hands on audit experience preferred. Detail and accuracy oriented, capable of multi-tasking. Computer literate (word & excel) and knowledgeable regarding one or more clinic billing software program, preferably Athena Collector. Strong on reporting skills, presentations and communication skills.  Knowledgeable Practice Management financial A/R management and billing related competencies.