Billing Integrity Specialist – Allergen Immunotherapy

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Input allergen immunotherapy charges and verify them for accuracy and adherence to federal and payer coding and billing regulations.

• Adhere to AP protocols and payer guidelines for precise CPT code entry and billing.

• Investigate payer manuals, guidelines, and billing regulations, and inform the Supervisor of any updates.

• Execute assigned tasks within specified timelines and performance benchmarks.

• Ensure compliance with federal, state, and payer requirements.

• Propose enhancements to processes and policies to the team lead.

• Collaborate with practice managers and staff regarding billing and payer policies, procedures, and regulations.

• Examine medical record documentation to assess the appropriateness of refill, restart, reformulation, and new orders.

• Research, evaluate, and respond to internal questions concerning charge entry, billable services, and denials.

• Work collaboratively across departments to ensure charges are entered into the practice management system in accordance with protocols and payer guidelines.

• Maintain comprehensive knowledge of payer clinical guidelines and reimbursement policies.

• Support accounts receivable billing representatives with insurance denials by reviewing records, providing education on billing issues, and facilitating resolutions.

• Assist with billing concerns and medical record review during the pre-billing review phase.

• Contribute to special billing integrity projects as assigned.

• Complete required training and adhere to the Code of Conduct, Compliance Program, and departmental policies.

• Carry out miscellaneous job-related tasks as assigned.

• No supervisory responsibilities.

⛳️ Requirements

• High school diploma or GED equivalent.

• Coding certification from AHIMA or AAPC is preferred.

• Two years of experience in physician office charge entry/billing involving complex regulations.

• Two years of experience in physician office operations.

• Strong oral and written communication skills.

• Proficient in Microsoft Office Excel and Word, as well as electronic health records.

• Four years of physician charge entry experience following complex rules is preferred.

• Two years of experience billing for multiple physicians and locations is preferred.

• Familiarity with practice management software and an EMR is preferred.

• Knowledge of medical terminology is preferred.

• Experience in billing for allergy specialty physicians is preferred.

• Understanding of billing and coding complexities related to specialty physician office charge entry.

• Ability to exercise independent judgment and handle confidential information.

• Knowledge of HIPAA and capability to maintain the confidentiality and privacy of PHI.

• Strong analytical and problem-solving skills.

• Excellent communication and interpersonal abilities.

• Understanding of regulatory and policy issues related to coding and billing.

• Awareness of current and emerging issues and trends in medical billing and payer requirements.

• Capability to clearly communicate billing requirements to providers, practice managers, and staff.

• Familiarity with and experience in electronic health records and physician practice management and billing applications.

• Exceptional organizational skills and the ability to manage multiple tasks within set timelines.

• Proficient in interdepartmental communication and collaboration.

🏝️ Benefits

• Comprehensive health, dental, and vision insurance.

• Retirement savings plan with employer matching.

• Generous paid time off and holiday schedule.

• Opportunities for professional development and training.

• Supportive work environment promoting work-life balance.