Billing Specialist - Radiation Oncology - Hopewell

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.

The listed pay range or pay rate reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time).

Pay Range:

Scheduled Weekly Hours:

Position Overview

ESSENTIAL FUNCTIONS

• Reviews, updates, corrects, and approves daily all case charges from sites within the billing system. Enters all medical and hospital charges, and other facility charges into the billing system. Assures accuracy of these charges and poses them electronically.
• Verifies in billing System that all charges for supplies, rooms, and other medical expenditures and assures their correct and accurate entry for proper reimbursement. Runs daily reports for cases and documents to validate accurate charges. Collaborates daily with nurses to add, change, update charges or documentation.
• Assists in obtaining insurance pre-authorizations for patient consults, exams, treatments, imaging for patients being treated. Assists in follow-up process for pending authorizations by providing necessary answers to questions from others or clinical documentation.
• Develops spreadsheet to track pre-authorizations and treatment codes to ensure compliance with current treatment plan. Coordinates peer to peer authorization process when authorizations are denied.
• Obtains base prices as needed for specific charges and manually enters them into the billing system. Acts as a resource for the department on any issues related to coding and billing. Follows up daily with outside departments on any issues, clarification, questions, or updates to ensure billing accuracy.
• Verifies against final patient orders and other documentation that all supply charges have been received. Revises and corrects any billing discrepancies provided by the billing department. Works collaboratively with other departments for billing related issues, pricing, coding, billing, and recalls.
• Assigns codes with accuracy rate in accordance with coding guidelines. Applies special codes (charge post) to certain procedures (cap pricing) for correct billing. Manually charges post the cap price CDM for all required from a capped price agreement.
• Discusses medical record information with physicians when necessary in accordance with coding guidelines. Contacts physicians or other staff to obtain missing documentation or signatures timely. Assists Medical Records, Compliance, and Finance Departments with appeals process by providing necessary documentation.
• Tracks medical records requests from Patient Account Department billers and reviews to ensure compliance. Prepares and communicates to appropriate parties on medical records reports and overdue medical records for purpose of satisfying claims to increase revenue.
• Performs other duties as assigned.

MINIMUM REQUIREMENTS

• Education: High school diploma or GED.
• Experience: Two years of medical insurance, insurance preauthorization, billing, or coding experience. Previous hospital billing experience preferred.
• Other Credentials:
• Knowledge and Skills: Intermediate experience with billing. Familiarity with insurance language. Basic understanding of coding preferred.
• Special Training: Basic computer skills. Understanding of ICD-9 and CPT coding classifications. Thorough knowledge of medical terminology, anatomy, and physiology.
• Mental, Behavioral and Emotional Abilities: Strong interpersonal skills. Able to interact with insurance companies and physicians. Works well in team settings. Excellent organizational skills. Excellent follow-up skills.

PHYSICAL DEMANDS AND WORK ENVIRONMENT

• Frequent physical demands include: Sitting , Wrist position deviation , Pinching/fine motor activities , Keyboard use/repetitive motion
• Occasional physical demands include: Standing , Walking , Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Squat/kneel/crawl
• Continuous physical demands include:
• Lifting Floor to Waist 15 lbs. Lifting Waist Level and Above 10 lbs.
• Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Color Discrimination, Minimal Depth Perception, Minimal Hearing
• Anticipated Occupational Exposure Risks Include the following: Dust/Particulate Matter

IND123

This position is eligible for the following benefits:

• Medical Plan

• Prescription drug coverage & In-House Employee Pharmacy

• Dental Plan

• Vision Plan

• Flexible Spending Account (FSA)

- Healthcare FSA

- Dependent Care FSA

• Retirement Savings and Investment Plan

• Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance

• Supplemental Group Term Life & Accidental Death & Dismemberment Insurance

• Disability Benefits – Long Term Disability (LTD)

• Disability Benefits – Short Term Disability (STD)

• Employee Assistance Program

• Commuter Transit

• Commuter Parking

• Supplemental Life Insurance

- Voluntary Life Spouse

- Voluntary Life Employee

- Voluntary Life Child

• Voluntary Legal Services

• Voluntary Accident, Critical Illness and Hospital Indemnity Insurance

• Voluntary Identity Theft Insurance

• Voluntary Pet Insurance

• Paid Time-Off Program

The pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level. 

The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.