• Enter CPT and diagnostic codes into EMR accurately and efficiently. • Review and process insurance claims, ensuring accuracy and completeness of all necessary information. • Follow-up on unpaid claims via insurance portals and payor calls. • Post patient payments and EOB’s received in the mail, and ERA’s from payors. • Address and resolve billing disputes, discrepancies, and denied claims. • Process medical record requests and submit records via fax, e-mail or portal to third parties and/or insurance companies. • Maintain detailed records of billing inquiries, and resolutions.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Medical Coding Specialist (Internally called a Coding Specialist) is responsible for creating and writing reports based on medical records and appropriate guideline criteria. This position utilizes the system database to determine usual and customary and/or state fee schedule allowances and is responsible for analyzing provider billing for proper coding and billing guidelines across all provider types. - Receive and input client and examinee data in the system database. - Sort and verify each claim. - Process and review each claim and address all necessary modifications manually. Contact Client as needed. - Perform quality assurance on every case prior to completion. - Ensure all medical records and reports are properly documented and saved in the appropriate location and available for audit at all times. - Process client invoicing in accordance with the client’s fee schedule. - Handle and respond promptly to incoming calls, emails, or faxes from clients requesting report status and/or information. - Provide notification to the Supervisor of any provider appeals and follow directions as given to resolve the claim. - Provide testimony in court as to the content of prepared reports, as required. Travel as necessary. - Ensure all practices are carried out in accordance with HIPAA compliance practices, state and federal safety standards, and legal regulations. - Perform quality assurance on various coding related reviews. - Perform other duties as assigned. Qualifications - High school diploma or equivalent required. - Minimum one year medical billing experience; or equivalent combination of education and experience required. - Must possess current coding certification in OASIS, RAC-CT, CCS, CPC, RHIT or RHIA. CPMA certification preferred. Requirements - Must have a full understanding of aspects of medical billing. - Must demonstrate understanding of the various types of medical billings and ability to identify which system database should be used. - Must be able to cross-reference different types of billings to ensure consistency in the review process. - Must possess knowledge of standard fee schedule review, UC&R review, drug and supply charges, rarity, utilization review, CPT guidelines, ICD 10, bundling/unbundling, duplicate billing, and CMS reimbursement guidelines. - Must possess complete knowledge of general computer, fax, copier, scanner, and telephone. - Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet. - Must have a full understanding of HIPAA regulations and compliance. - Must be a qualified typist with a minimum of 35 W.P.M. - Ability to follow instructions and respond to management’s directions accurately. - Ability to work independently, prioritize work activities, and use time efficiently. - Must be able to maintain confidentiality. - Must be able to demonstrate and promote a positive team-oriented environment. - Must be able to stay focused and concentrate under normal or heavy distractions. - Must be able to work well under pressure and/or stressful conditions. - Must possess the ability to manage change, delays, or unexpected events appropriately. - Ability to follow all company policies and procedures in effect at the time of hire and as they may change or be added from time to time. Benefits - Competitive benefits (medical, vision, dental) - Paid time off - 401k

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Medical Coding Specialist (Internally called a Coding Specialist) is responsible for creating and writing reports based on medical records and appropriate guideline criteria. This position utilizes the system database to determine usual and customary and/or state fee schedule allowances and is responsible for analyzing provider billing for proper coding and billing guidelines across all provider types. Ensures reviews are completed with the highest quality and integrity and that all work is in full compliance with client contractual agreements, regulatory agency standards, and/or federal and state mandates. Schedule for this role is: Monday - Friday 8am-5pm EST - Receive and input client and examinee data in the system database. - Sort and verify each claim. - Process and review each claim and address all necessary modifications manually. Contact Client as needed. - Perform quality assurance on every case prior to completion. - Ensure all medical records and reports are properly documented and saved in the appropriate location and available for audit at all times. - Process client invoicing in accordance with the client’s fee schedule. - Handle and respond promptly to incoming calls, emails, or faxes from clients requesting report status and/or information. - Provide notification to the Supervisor of any provider appeals and follow directions as given to resolve the claim. - Provide testimony in court as to the content of prepared reports, as required. Travel as necessary. - Ensure all practices are carried out in accordance with HIPAA compliance practices, state and federal safety standards, and legal regulations. - Perform quality assurance on various coding-related reviews. - Perform other duties as assigned. Qualifications - High school diploma or equivalent required. - Minimum one year medical billing experience; or equivalent combination of education and experience required. - Must possess current coding certification in OASIS, RAC-CT, CCS, CPC, RHIT, or RHIA. CPMA certification preferred. Requirements - Must have a full understanding of aspects of medical billing. - Must demonstrate understanding of the various types of medical billings and ability to identify which system database should be used. - Must be able to cross-reference different types of billings to ensure consistency in the review process. - Must possess knowledge of standard fee schedule review, UC&R review, drug and supply charges, rarity, utilization review, CPT guidelines, ICD 10, bundling/unbundling, duplicate billing, and CMS reimbursement guidelines. - Must possess complete knowledge of general computer, fax, copier, scanner, and telephone. - Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet. - Must have a full understanding of HIPAA regulations and compliance. - Must be a qualified typist with a minimum of 35 W.P.M. - Ability to follow instructions and respond to management’s directions accurately. - Ability to work independently, prioritize work activities, and use time efficiently. - Must be able to maintain confidentiality. - Must be able to demonstrate and promote a positive team-oriented environment. - Must be able to stay focused and concentrate under normal or heavy distractions. - Must be able to work well under pressure and/or stressful conditions. - Must possess the ability to manage change, delays, or unexpected events appropriately. - Ability to follow all company policies and procedures in effect at the time of hire and as they may change or be added from time to time. Benefits - Competitive benefits (medical, vision, dental) - Paid time off - 401k

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Under the supervision of the Hospital Manager of Medical Staff Services/DUHS CVO, the Medical Staff Services Coordinator is responsible for coordination of aspects of DUHS Medical Staff Services office by providing essential verification and quality control functions to support DUHS's goals for credentialing and privileging health care providers while ensuring adherence to legal, regulatory, and delegated requirements. - Organizing and directing a comprehensive and specialized credentialing program to assure continued accreditation compliance by the Joint Commission, NCQA, and AAAHC. - Interpretation, explanation and following all regulatory guidelines, including medical staff bylaws, fair hearing plan, rules and regulations and policies. - Maintaining accuracy in the Credentialing database to identify medical staff members and their clinical privileges; prepares and maintains other related records and reports. - Receives application/reappointment application from the CVO, oversees the completion of the credentialing process for medical, professional, and advanced practice professional staff. - Coordinating, monitoring and maintaining the credentialing and re-credentialing process. - Works with medical staff leadership and hospital clinical staff for the approval and ongoing review of credentialed practitioners. - Monitoring and revising credentialing and privileging/scope of practice forms as needed. - Scheduling and supporting the Credentials Committee; prepares agenda, attends and prepares minutes. - Communicating medical staff information to appropriate departments; including approval notices to the provider, and other entities. - Demonstrates effective leadership skills and coordination of intra-department activities and inter-department integration. - May develop and facilitate the medical staff orientation, as well as other onboarding activities. - Perform other related duties incidental to the work described herein. Qualifications - Work requires analytical, communications and organizational skills generally acquired through completion of a bachelor's degree program. - In lieu of bachelor's degree, four years relevant experience in Managed Care or Medical Staff Credentialing/Privileging. - One year of experience in a Medical Staff/Managed Care credentialing office. - Certification by NAMSS (CPMSM or CPCS) strongly preferred. Company Description At Duke Health, we're driven by a commitment to compassionate care that changes the lives of patients, their loved ones, and the greater community. No matter where your talents lie, join us and discover how we can advance health together.