Women’s Health Specialists offers an outstanding company culture, one rich in teamwork, strong ethics and focused on customer service. Those factors have helped us grow into one of the best OB/GYN clinics in the Appleton and Neenah area, being voted “Best of the Valley” for eleven years in a row.
Our independent practice has been serving the reproductive health needs of women in the Fox Valley for the last 50 years. Our Doctor-Nurse teams work with women to educate and empower them to make the best health decisions possible. We believe each patient deserves personalized care and clinical excellence, through all stages of her life. We are committed to providing compassionate, individualized care and we focus on establishing long lasting relationships with our patients. We are a private, physician-owned practice, committed to our community with 3 locations in Appleton and Neenah.
To apply for any of our positions, please submit a cover letter and resume in the email box that pops up when you click “Apply Online” to the right of your screen.
Join Our Team
Medical Billing and Coding Specialist
Open Position: Medical Billing and Coding Specialist
To Apply: Please submit a resume and cover letter in response to this posting.
This position is a full-time, 4 day per week position.
The Medical Billing and Coding Specialist is a key position in the Revenue Cycle that manages the claim process, including accurate and timely claim creation, follow-up and correspondence with providers, insurance inquiries/correspondence. This position will assist in the clarification and development of process improvements and inquires, assure payment related to patient services from all sources are recorded and reconciled timely to maximize revenues. Other important duties include coding, credentialing, and resolving claim issues and denials.
- Evaluate medical record documentation and coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflects and supports visits and to ensure that data complies with legal standards and guidelines.
- Interprets medical information such as diseases or symptoms and diagnostic descriptions and procedures to accurately assign and sequence the correct codes.
- Reviews all claims for completeness and accuracy before submission to minimize claim denials
- Evaluates records and prepares reports on topics such as the number of denied claims or documentation or coding issues for review by management and/or committees
- Makes recommendations for changes in policies and procedures; updates procedures to maintain standards for correct coding to minimize the risk of fraud and abuse, and to optimize revenue recovery.
- Provides technical guidance to physicians and other staff in identifying and resolving issues or errors such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, and/or codes that do not conform to coding principles/guidelines
- Reads bulletins, newsletters, and other periodicals to stay abreast of issues, trends, and changes in laws and regulations governing medical record coding and documentation
- Educates and advises staff on proper code selection, documentation, procedures, and requirements
- Identifies training needs and conducts training to staff as needed to improve skills in the collection and coding of quality health data
- Submits claims to a variety of payment sources, including Medicaid and Medicare, and other third-party payers. Prepares, reviews, and transmits claims using EPIC, including electronic and paper claim processing.
- Maintains communication with patients and third-party payers until accounts are paid or referred to another appropriate agency for further collection activity.
- Posts payments from both patients and third-party payers to patient accounts
- Verifies insurance reimbursements for accuracy and compliance with contract discounts
- Contacting insurance companies regarding any discrepancies and or denials
- Identifies and coordinates the billing of secondary or tertiary insurances
- Coordinates collection process, to include any projects with a collection agency and financial counselor
- Manages daily statement process, including reviewing statements before sending and fielding any patient inquiries
- Coordinates and administers policy and procedure for payment plans and auto-pay patients
- Collaborates and works with front desk staff to ensure appropriate collection of self-pay, copay, and balance due
- Handles patient inquiries as well as questions from other staff and insurance companies
- Identifies and resolves any patient billing related problems, denials, and insurance company follow up
- Oversee patient accounts and process refunds as necessary
- Audits current procedures to monitor and improve the efficiency of the revenue cycle by making recommendations for process improvement (billing and collections operations).
- Ensures that the activities of the billing and collections operations are conducted in a manner that is consistent with overall department protocol, and compliant with Federal, State, and payer regulations, guidelines, and requirements.
- Analyzes trends impacting charges, coding, collection, and accounts receivable and makes recommendations for improvement.
- Understands and remains updated with current medical accounts receivable and billing regulations and compliance requirements.
- Maintains working knowledge of all health information management issues such as HIPAA and all health regulations.
- Coordinates provider enrollments in all commercial, state, and federal insurance programs with Management and correspond to payer requests for updates to information
- Provide data and support to Management as needed
Education and Experience:
- Associates degree in accounting, business, finance, medical billing, or related field, preferred. Also preferred is experience with an electronic medical record system, especially Epic.
- Two (2) years Medical Insurance/Healthcare Billing, Prior Authorization and Collections experience in a medical practice or health system, with a deep understanding of medical billing rules and regulations. A combination of education and experience will be considered.
- Experience working with a variety of medical payers including Medicare, Medicaid, and commercial insurance
- Experience working with EPIC
- Working knowledge of CPT, ICD-9 & ICD-10, ANSI coding systems; coding certification preferred, but not required
Knowledge, Skills, and Abilities:
- Must possess a thorough understanding of medical billing and coding, insurance verification and authorization, collections, payment posting, revenue cycle, and third-party payers.
- Excellent verbal and written communication skills
- Excellent interpersonal and customer service skills
- Excellent organizational skills and attention to detail
- Excellent problem solving and investigation skills
- Works well in an environment with firm deadlines and is results-oriented
- Ability to work both independently and as part of a team
- Microsoft Office proficiency required.
- Ability to read, speak and write English fluently.
- Must be able to work standard office equipment: computers, fax machines, copiers, printers, telephones, etc.
- Ability to make timely, independent decisions
- Prolonged periods of sitting at a desk and viewing/using a computer
- Prolonged repetitive movements of hands, fingers, and arms for typing and/or writing during work shift
- Ability to read and view fine print
- Ability to reach, stoop, and bend to retrieve files and supplies to complete tasks
- Must be able to lift, carry or otherwise move and position objects weighing 10-20lbs at times
- Continuous use of the telephone to verbally speak to insurance companies and patients
- Must be able to handle high-stress situations with multiple tasks having similar deadlines