Certified Biller II

Job Title: Certified Biller II

Department/Location : Skylands Medical, Newton, NJ

Reports to: Chief of Staff, Office of the CMO

FLSA Status: Non-Exempt

Direct Reports: None

Company Overview

At Consensus Health, we believe better healthcare begins with a community of strong, independent providers delivering high quality, compassionate patient care with improved outcomes. As New Jersey’s fasting growing independent medical group, Consensus Health offers full clinical and operational integration with our value-based care programs, enabling providers to transform the healthcare delivery experience. In addition, Consensus Health owns and manages New Jersey’s oldest Independent Physician Association (“IPA”) with over 1,000 providers throughout the state. At Consensus Health we believe in fostering an environment of collaboration, participation, and respect. A cornerstone of that belief is a commitment to attracting talented and dedicated team members who work together for the common purpose of providing clinical excellence.

Consensus is committed to attracting, developing, and retaining talented people who are passionate about helping physicians and their staff deliver better care to patients and whose values align with ours. We empower our employees to bring the right solutions forward to strengthen the relationship between providers and patients and ensure that our staff are well served.

Position Summary

Provide client audits for all providers. The medical record or progress note will be audited for documentation to ensure compliance. Interacts with the practices non-provider and provider employees. Provides analysis to the providers for education.

Duties and Responsibilities

The duties include, but are not limited to:

• Audits medical record documentation to identify under coded and up coded services; prepares reports of findings and meets with providers to provide education and training on accurate coding practices and compliance issues.
• Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services.
• Interacts with physicians and other patient care providers regarding billing and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific documentation.
• Interacts with providers and management to review and/or implement codes and to update charge documents.
• Generates reports as needed through various systems.
• Assist in provider education.
• 25% travel through the state of NJ.
• Performs miscellaneous job-related duties as assigned.

Qualifications or Education, Training and Experience

• High School diploma or GED
• Certificate in Medical Coding (AAPC) (AIHMA) or equivalent; at least 2- 3 years of experience directly related to the duties and responsibilities specified.

Knowledge and Skills/Expected Competencies

• Proficient in Microsoft Office Suite software and Windows 10.
• Knowledge of auditing concepts and principles.
• Advanced knowledge of medical coding and billing systems and regulatory requirements.
• Ability to use independent judgment and to manage and impart confidential information.
• Ability to analyze and solve problems.
• Strong communication and interpersonal skills.
• Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation.
• Knowledge of current and developing issues and trends in medical coding procedures requirements.
• Ability to clearly communicate medical information to professional practitioners and/or the public.
• Detailed knowledge of medical coding systems, procedures, and documentation requirements.
• Ability to adapt and modify medical billing procedures, protocol, and data management systems to meet specific operating requirements.
• Ability to provide guidance and training to professional and technical staff in area of expertise.

Physical/Mental Demands and Work Environment

The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit, stand, walk and use hands and arms to operate general office equipment (PC, telephone, printer, etc.). The employee may occasionally lift and/or move between 10 and 25 pounds. The employee may need to travel to healthcare practices.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. The noise level in the work environment is usually low to moderate.

The Company reserves the right to modify the job description based upon its needs and may require the employee to perform functions beyond those mentioned above. Neither this job description nor any other communication creates an employment contract between the Company and the employee.

Equal Employment

Our culture encourages individual development, embraces an inclusive environment, rewards innovative excellence, and leads New Jersey in provider and patient satisfaction. Consensus Health values diversity, inclusion, and equity as matters of fairness and effectiveness. We are committed to hiring and retaining a staff that reflects the diversity of the communities we serve, fostering an inclusive working environment where staff of all backgrounds feel welcomed and engaged.

Consensus Health is an Equal Opportunity Employer and encourages applications from individuals underrepresented in the medical sector, including people of color, and persons with non-traditional work and educational experience. All who believe they meet the stated qualifications are invited to apply.

Company Safety

We believe that the best care for our patients starts with the best care for our employees. Consensus Health is committed to proactively creating and maintaining an environment that is safe for our team and patients. Employees are required to wear Personal Protective Equipment (PPE) including face masks, gloves, gowns, and more as appropriate.