WVUH Specialty Pharmacy & Home Infusion · 2 months ago
Billing and Coding Specialist (FT)
Wheeling Hospital (WHH)
Full-time
Onsite
Entry Level
1+ years expWVUH Specialty Pharmacy & Home Infusion is seeking a Billing and Coding Specialist to support their operations. The role involves monitoring billing practices, ensuring compliance, and providing insights for budget management while liaising with clinical staff and IT.
Hospital & Health Care
Responsibilities
Provide data insights for the purpose of Waiver budget creation, update and maintain waiver budget reconciliation tool, and create pivot tables for IDD waiver budget review
Monitor team Dash Board update and manage team SharePoint
Filter Tickets in billing system prior to sending the information to IT
Conduct billing system configuration insight and repair by partnering with IT and create work flow instructions for billing system
Monitor monthly waiver billings against projected monthly budgets to assure current residential schedules agree to actual billings and partners with case managers to resolve issues
Perform random audit functions (billing vs payroll) for non-24 hours client members
Identify all patients requiring pre-certification or pre-authorization at the time services are requested or when notified by another hospital or clinic department
Follow up on accounts as indicated by system flags
Contact insurance company or employer to determine eligibility and benefits for requested services
Follow up with the patient insurance company or provider if there are insurance coverage issues in order to obtain financial resolution
Use work queues within the designated EMR or appropriate system for scheduling, transition or care, and billing edits
Perform medical necessity screening as required by third party payors
Document referrals/authorizations/certification numbers in the designated EMR
Communicate with the patient the anticipated self-pay portion co-payments/deductibles/co-insurance, and account balance refers self-pay, patients with limited or exhausted benefits to the in-house Financial Counselors to determine eligibility
Maintain current knowledge or major payor payment provisions and regulations and participate in educational programs to meet mandatory requirements and identified needs with regard to the job
Assist Patient Financial Services with denial management issues and will appeal denials based on medical necessity as needed
Analyze patient charts carefully to know the diagnosis and represent every item with specific codes
Collect health information as documented by clinicians and code appropriately
Communicate with clinicians for further clarification and understanding of items on patient charts to avoid any misinterpretations. Provide accurate answers to queries on coding
Ensure that codes tally with clinicians’ diagnosis
Advocate for patients where their medical history is needed as evidence
Collect and distribute coding related information and billing issues to UM, Billing department, and Clinicians
Qualification
Required
High school graduate or equivalent
State criminal background check and Federal (if applicable), as required for regulated areas
One (1) year of medical billing experience
Preferred
Waiver billing experience
System billing experience
Finance experience
Company
WVUH Specialty Pharmacy & Home Infusion
WVUH Specialty Pharmacy & Home Infusion
51-200 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase