Healthcare Coding and Billing Specialist

About Company

Samaritan Ministries is a Biblical solution to health care. It is not insurance. We deliver authentic, compassionate, and personal service in the name of Christ to enable and inspire members to provide for one another’s medical needs through prayer, encouragement, and financial support.

From demonstrating Christ-centered compassion to modeling best practices in health care sharing, Samaritan Ministries is committed to keeping Jesus at the center of everything we do. The way we interact with our colleagues and engage with our members is a testament that we are ultimately serving Christ and His Kingdom.

Summary

To serve the members of Samaritan Ministries International (SMI) through quantitative and qualitative contribution to the work of the ministry by performing a variety of tasks related to the ongoing maintenance and set-up of the medical bill adjudication system.

Competencies

• Acting with Integrity, Empathy, and Compassion
• Collaborating with Others
• Neighbor Focus
• Pursuing Excellence
• Improving Business Processes
• Analytical Thinking
• Problem Solving
• Product and Technical Knowledge
• Systems Integration

Key Responsibilities

• Staff are expected to meet established goals and clearly communicated expectations regarding both the quantity and quality of their work. They should demonstrate effective time management and prioritization skills, work independently with appropriate guidance from senior staff, and consistently apply training and acquired knowledge to fulfill their responsibilities.
• Know the Healthcare sharing matching and allocation process from beginning to end.
• Create, troubleshoot and maintain medical bill adjudication system additions, terms, and changes.
• - Implement adjudication system upgrades which improve communication logic within the system processes.
• - Configure and maintain the medical bill adjudication system mapping and all interface modules.
• - Maintain medical bill adjudication system mapping parameters throughout the system.
• Collaborate to develop, implement, and improve cross-functional work processes which support adjudication and proper provider payment.
• Report on system, adjudication, and allocation performance.
• Review and analyze medical bills to ensure accurate application of ICD-10, CPT, and HCPCS codes.
• Conduct coding audits and quality assurance reviews to maintain compliance and accuracy.
• Uphold member confidentiality and adheres to data security standards.
• Collaborate with TPAs and internal member care specialists to resolve billing discrepancies.
• Implement continuous quality improvement processes to help identify systemic issues in Bill/Needs processing and reduce rework.
• Support special projects.

Qualifications and Experience

• Bachelor’s degree or equivalent in experience.
• Medical Bill Auditing Experience
• Reference Based Repricing experience (CMS, IPPS, Usual & Customary, Fee Schedule etc.)
• CMS Coding and Billing Edits Experience
• AAPC Coding and Billing Certification (Preferred)
• Staff are required to possess applicable knowledge to bring value to SMI in this role, know and utilize resources well, ask questions to ensure full understanding. gain and retain knowledge to keep up with changes, and accept and engage with training to grow knowledge for current and future responsibilities.
• Knowledge and understanding of organizational structure especially of Validator and Member Care Specialist roles and responsibilities
• Knowledge of Redeem Programs & Guidelines
• Familiarity of Healthcare forms such as HCFAs and UBs
• Familiarity with EDI (837I, 837P)
• Familiarity with Healthpac or other Adjudication Platform experience
• Knowledge of Vendor management Experience
• Software: Javelina, Sharable, HubSpot, others as needed

Additional Information

• Tasks are normally conducted in a regular office environment, requiring use of computer and mouse and other standard office equipment. Staff usually remain in a stationary position, often standing or sitting for prolonged periods.
• May need to lift and move items up to 35 lbs on occasion.
• Staff will observe safety principles while performing the duties of the position.
• Onsite staff will be required to travel to office and have a valid driver’s license.
• Disclaimer: This job description is intended to describe the general nature and level of work being performed by people assigned to this job. They are not intended to be an exhaustive list of responsibilities, duties and skills required of personnel in the classification. Work hours may be irregular, including performing duties on evenings or weekends.
• This position requires an active commitment to the mission and values of SMI. In the course of performing job duties, the employee will act in a manner that is Christ-honoring as well as Christ-like, demonstrating a personal Christian faith and witness in all interpersonal interactions.