StarCare Specialty Health System (StarCare) is seeking a full-time Accounts Receivable Coding Specialist to join its outstanding Finance team. The Accounts Receivable Coding Specialist is responsible for reviewing and analyzing client accounts, supporting billing and denial specialists, and maintaining a comprehensive database of billing codes across all programs to optimize billing processes. This role is essential in ensuring accurate and timely reimbursement for StarCare while supporting the organization’s financial health by reducing denial rates, improving claim recovery, and ensuring compliance with payer requirements and healthcare regulations.
Responsibilities:
- Maintain a comprehensive database of billing codes across all services and provider types.
- Monitor coding updates from CMS, TMHP, and third-party payers, and coordinate with financial staff to update systems and billing processes accordingly.
- Review and analyze client accounts to ensure accuracy and optimized coding.
- Review and analyze denied claims from Medicaid, Medicare, private insurance, and other third-party payers to identify trends and resolution opportunities.
- Investigate root causes of denials and take corrective actions, including claim resubmission, appeals, or coordination with other departments.
- Prepare and submit appeals with appropriate supporting documentation, ensuring accuracy and timeliness.
- Track appeal outcomes and follow up with payers to ensure timely resolution and maximize reimbursement.
- Collaborate with clinical, coding, and accounts receivable staff to address documentation or coding issues contributing to denials.
- Maintain detailed and organized records of denial activity, appeal status, and resolution outcomes.
- Ensure all denial management activities comply with HIPAA, payer guidelines, and internal policies and procedures.
- Stay informed of changes in payer rules, billing codes, and regulatory requirements that may impact claim processing and denial trends.
- Work closely with accounts receivable staff, clinicians, and administrative teams to implement denial prevention strategies and improve first-pass claim acceptance rates.
- Generate and present denial management reports to leadership, highlighting trends, root causes, and opportunities for process improvement.
- Participate in staff training and contribute to continuous improvement initiatives related to billing accuracy and denial reduction.
- Assist with billing and payment processes as needed, including claim corrections and coordination with the accounts receivable team.
- Maintain regular and consistent attendance for the assigned work hours.
- Ensure all required training and credentials are current and compliant with Center, federal, state, and local regulations, and in addition to StarCare policies and procedures.
- Complete special departmental projects and other responsibilities with similar skill and work conditions as assigned.
- Support all activities in alignment with StarCare’s mission, values, and operational goals.
Schedule:
This is a full-time, hybrid, position scheduled Monday – Friday, 8am – 5pm, with flexibility to meet the needs of the department.
Benefit Package:
StarCare offers an expansive benefit package including but not limited to: Company-paid medical coverage, fully funded employer contribution to HSA, company-paid life insurance, company paid hospital indemnity plan, retirement plan with up to 12% employer match, front loaded paid time off (PTO), thirteen (13) paid holidays, sabbatical leave, longevity augmentations, and employee referral augmentations.
Qualifications:
- CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) certification preferred.
- High school diploma or equivalent required.
- Bachelor’s degree in Business, Finance, Healthcare Administration, Accounting, or a related field preferred.
- Minimum of two (2) years of experience in denial management, medical billing, or insurance collections; equivalent combinations of education and experience may be considered.
- Familiarity with Medicaid and Medicare billing practices, CPT/HCPCS coding, EMR systems, and managed care contracts preferred.
- Must have a current Texas driver’s license and be insurable under the Center’s insurance.
- Must pass all pre-employment and annual screenings, including drug screen, criminal background, applicable registry checks, and MVR.
Skills & Abilities:
- Problem Solving: Ability to analyze situations, identify challenges, and develop effective solutions.
- Communication: Strong verbal, written, and electronic communication skills to convey information clearly and professionally.
- Collaboration: Ability to work effectively with others across teams and departments to achieve shared goals.
- Exhibiting Corporate Values: Demonstrates behaviors and decision-making aligned with the organization’s core values and mission.
- Documentation: Proficient in accurately recording, organizing, and maintaining information in various formats.
- Productivity & Reliability: Demonstrates consistent performance, meets deadlines, manages time effectively, and maintains dependability in fulfilling job responsibilities.
- Project and Outcome Management: Ability to plan, execute, and monitor tasks and projects to achieve desired outcomes within established timelines.