Billing Integrity Specialist-Allergen Immunotherapy

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. OTHERCompletes 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 RESPONSIBILITIESThis position has no supervisory duties. TYPICAL PHYSICAL DEMANDSNo 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.

QualificationsEDUCATIONAL REQUIREMENTS: High school diploma or GED equivalent. Coding certification from AHIMA or AAPC, preferredQUALIFICATIONS 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, preferredExperience with practice management software and an EMR, preferredKnowledge of medical terminology, preferredExperience in allergy specialty physician billing, preferredKnowledge 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.