Sr. Billing Specialist

Under the general supervision of the Ambulatory Compliance/Billing Supervisor and in accordance with established guidelines, ensures the accurate assignment of diagnostic, service, and procedure codes for ambulatory patient encounters. Responsibilities include qualitative analysis of ambulatory medical records to assign ICD9, CPT, and E/M codes in compliance with hospital standards. Serves as a coding and billing resource to departmental staff and researches and reconciles coding errors or omissions.

Brown University Health employees are expected to role model the organization's values of Compassion, Accountability, Respect, and Excellence, which guide everyday interactions with patients, customers, and colleagues.

In addition, all employees are expected to demonstrate the organization's core Success Factors, including:

• Instilling Trust and Valuing Differences
• Patient and Community Focus
• Collaboration

• Review ambulatory medical records and patient encounter forms to identify and assign appropriate diagnosis and procedure codes.
• Reference coding manuals (ICD9, CPT4, HCPCS) to ensure accurate billing code assignment.
• Apply sequencing guidelines in accordance with established coding protocols, AHIMA Code of Ethics, and CMS directives.
• Contact physicians or other healthcare professionals to clarify or obtain missing or ambiguous documentation.
• Enter coding and billing information into the hospital's computerized billing system and create paper invoices as needed.
• Review revenue reports regularly to reconcile charges and address missing charges or corrections.
• Interact with patients to resolve billing issues, including claim denials.

• Perform regular audits to ensure documentation accuracy, completeness, and compliance with payer reimbursement policies and governmental regulations, including Medicare/CMS guidelines.
• Review medical records to assess adequacy of documentation supporting diagnoses, procedures, complications, comorbidities, and secondary diagnoses.
• Report documentation inconsistencies to the supervisor.
• Maintain current knowledge of outpatient compliance, medical necessity, reimbursement policies, and coding standards.
• Serve as a departmental resource for coding and billing questions; escalate complex issues to the supervisor.

• Record all payments, including:
  • Lockbox payments
  • Mailed patient checks
  • Cash, checks, and credit card payments received at time of service
  • Wire transfer and misdirected payment notices from Cash Control
  • United Healthcare (Rite Smiles) and DHS (Medicaid) electronic remittances
• Post payments and adjustments to patient ledgers using Dentrix dental software.
• Correct and resubmit denied claims to third-party payors.
• Prepare daily bank deposits and cashier reports for Cash Control.
• Maintain spreadsheets for receipt books, petty cash reconciliation, daily deposits, and monthly manager reporting.

• Submit claims electronically through Dentrix and a clearinghouse.
• Continuously audit patient ledgers to correct errors and prevent insurance issues.
• Research past-due accounts and resubmit claims to insurance plans on a monthly basis.

• High School Diploma or equivalent.
• Completion of formal education and training in ICD9 and CPT coding, anatomy, physiology, and medical terminology.
• Preferred certifications:
  • Registered Medical Coder (CMR)
  • Certified Coding Specialist (CCS/CCR)
  • Certified Professional Coder (CPC or CPCH)

• Minimum of two years of experience in coding and billing using a hospital-based online billing system.
• Demonstrated expertise and accuracy in medical code assignment.

• Clinic-based environment requiring walking, sitting, and standing throughout the day.

• None