Billing Integrity Specialist-Allergen Immunotherapy

POSITION: Billing Integrity Specialist – Allergen Immunotherapy

RESPONSIBLE TO: Supervisor, Allergen Immunotherapy Billing

JOB SUMMARY: The Billing Integrity Specialist - Allergen Immunotherapy reports to the Supervisor, Allergen Immunotherapy Billing. Primary duties include: entering allergen immunotherapy charges and reviewing for accuracy in compliance with federal and other payer coding and billing regulations and guidelines; following established AP protocols and payer policies to ensure accurate entry of CPT codes and billing of allergen immunotherapy; researching payer manuals and guidelines related to allergen immunotherapy billing rules and notifying the Supervisor, Allergen Immunotherapy Billing with updates.

RESPONSIBILITIES INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING:

- Performs assigned duties within the designated timelines and performance standards.

- Complies with Federal, States and payer requirements.

- Enters allergen immunotherapy charges in accordance with payer claims editing and other payer policies, and AP policies and procedures.

- Recommends to the team lead improvements to processes and/or policy and procedures.

- Interacts with practice managers and staff regarding billing and payer policies, procedures, and regulations as they relate to allergen immunotherapy charge entry.

- Reviews medical record documentation to determine if refill, restart, reformulation, and new orders are appropriate in accordance with Allergy Partners policy.

- Follows established protocols and conducts research on payer policies related to allergen immunotherapy billing.

- Researches, analyzes, and responds to internal inquiries regarding allergen immunotherapy charge entry, billable services and denials.

- Work interdepartmentally to ensure that all charges are entered into practice management system according to established Allergy Partners protocols and payer guidelines.

- Maintain in depth knowledge of payer requirements, both clinical guidelines and reimbursement policies.

- Assist billing representatives in accounts receivable with insurance denials by reviewing medical records, educating on billing issues as identified, and facilitating resolution.

- Assists with resolving billing issues and reviews medical record documentation in conjunction with the AP pre-billing review process.

- As assigned, assists with special billing integrity projects.

- Models the AP Code of Conduct and demonstrates a commitment to the AP Compliance Program, standards and policies.

- Completes all assigned AP training within designated timeframes.

- Performs miscellaneous job-related duties as assigned.

OTHER

- Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated timeframes.

- Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance & Privacy or via the AP EthicsPoint hotline.

- Models the AP Code of Conduct and demonstrates a commitment to the AP Compliance Program, standards and policies.

SUPERVISORY RESPONSIBILITIES

This position has no supervisory duties.

TYPICAL PHYSICAL DEMANDS

- No or very limited exposure to physical risk.

- No or very limited physical effort required.

- Work is normally performed in a typical interior/office work environment.

Qualifications

EDUCATIONAL REQUIREMENTS:

- High school diploma or GED equivalent.

- Coding certification from AHIMA or AAPC, preferred

QUALIFICATIONS AND EXPERIENCE:

- Two years of physician office charge entry/billing following complex rules.

- Two years of experience in physician office operations.

- Oral and written communication skills.

- Competent in use of Microsoft Office Excel and Word, and electronic health records.

- Four years of physician charge entry following complex rules, preferred

- Two years of experience in billing for multiple physicians and locations, preferred

- Experience with practice management software and an EMR, preferred

- Knowledge of medical terminology, preferred

- Experience in allergy specialty physician billing, preferred

- Knowledge of billing and coding complexities related to specialty physician office charge entry.

- Ability to use independent judgment and to manage and impart confidential information.

- Understands the Health Insurance Portability and Accountability Act (HIPAA) and maintains confidentiality and privacy of protected health information (PHI).

- Ability to analyze and solve problems.

- Strong communication and interpersonal skills.

- Knowledge of regulatory and policy issues related to coding and billing.

- Knowledge of current and developing issues and trends in medical billing and payer requirements.

- Ability to clearly communicate billing requirements to providers, practice managers and to staff.

- Understanding of and experience with electronic health records; computer applications used for physician practice management and billing.

- Excellent organizational skills and the ability to manage multiple tasks within designated timelines.

- Ability to communicate and work proficiently interdepartmentally.