Sr Billing Specialist

Under the general supervision of the Ambulatory Compliance/Billing Supervisor but according to established guidelines ensures accurate assignment of diagnostic service and procedures coding of ambulatory patient encounters. These duties include qualitatively analyzing ambulatory patients� medical record to assign ICD-9 CPT or E/M codes within the parameters of the Hospital�s standards. Functions as a coding/billing resource to department staff. Researches and reconciles coding errors or omissions.


Reviews medical record documents and patient encounter forms for ambulatory patients to identify and assign appropriate diagnosis and procedure codes. References appropriate coding manuals to ensure accurate assignment of billing codes (such as ICD-9 CPT-4 HCPCS). Applies sequencing guidelines to coded data according to established coding protocols and in compliance with the American Health Information Management Association (AHIMA�s) Code of Ethics and considering directives from the Centers for Medicare & Medicaid Services (CMS).

Contact physicians or other health care professionals to obtain or clarify missing or ambiguous information contained within the record.

Enters coding/billing information into the Hospital�s computerized billing system. As necessary creates paper invoices.

Prepare and submit completed UB92 forms for services and procedures performed within the outpatient facility in a timely manner.

Reviews related revenue reports regularly to reconcile charges on patient encounter forms against the reported data. Researches and reconciles missing charges and/or corrections into the billing system. Interacts with patients and Patient Financial Services in order to resolve billing issues including denials.

Performs regular audits to identify completeness and accuracy of documentation and to promote and maintain compliance with payor reimbursement policies and governmental regulations (including Medicare/CMS guidelines). May review medical records to assess the adequacy of documentation to ensure appropriate support for the principal diagnoses principal procedure complications co-morbid conditions secondary diagnoses and procedures to facilitate the accuracy and completeness of coding activities. Reports inconsistencies in documentation to supervisor.

Functions as resource to others within the department including coding and professional staff for questions related to coding and billing activities. Maintains knowledge of outpatient compliance and reimbursement policies and practices including medical necessity and coding issues. Refers more complex questions or issues to supervisor.

Performs the attached list of duties/ responsibilities and other related duties as

Rhode Island Hospital � Ambulatory Coding/Billing Specialist Job Code R18405

In addition to the duties listed for the Job Code above the Samuels Sinclair Dental Center coding/billing specialist:

Payment Reporting and Posting:

Records all payments including:

- Lock Box payments

- Live checks from patients that are mailed directly to the dental center

- Cash checks and credit card payments received at time of service

- Faxes from cash control listing wire transfers and misdirected payments

- Downloaded United Healthcare (Rite Smiles) and DHS (Medicaid) remittances

Post payments and appropriate adjustments to patient ledgers in Dentrix dental software

Correct and resubmit denied claims to third party payors

Prepare daily deposits for Sovereign Bank and cashiers report for Cash Control

Maintain spread sheets for receipt books petty cash reconciliation daily deposits and report to manager monthly.

- Billing specialist receives a report from Finance for all general ledger postings to Samuels so that they can be aware of any missing adjustments or payments from Patient Financial Services. At this point they advise Finance of any missing postings before the month end.

- Reviews all posted amounts daily and keep a spread sheet in Excel to have manager verify daily

Reconcile deposits with all posted payments in Dentrix at the closing of each month and report any carried over amounts Finance Adult Ambulatory Care Administration

Oral Surgery Contracted Services:

- University Oral and Maxillofacial Surgery contracts with RIH to provide services to patients of the dental center ED and inpatient units. Demographic information must be obtained for 10 to 15 new patients per month. Charges for 80 to 100 patients per month are entered into Dentrix and billed. Additional information or documentation may need to be obtained. Day sheets are run to confirm that all charges were entered.

- Knowledge of medical coding and specialty billing rules is needed. A separate fee schedule is maintained. Compliance with terms of the service agreement is monitored.

Electronic Billing:

- Claims are sent electronically via Dentrix dental software and a clearing house. Accurate files of provider information must be maintained.

- Bradley hospital patients are treated at the dental center under a special agreement. Patient information must be provided to Finance.

- Paper claims and prior authorizations are required for services provided to patients covered by 2 different grant-funded organizations.

- Community Free Service claims are researched and written off if they fall under the guidelines of Samuels Sinclair Dental Center CFS policy charges or billed to the patient at 50% charity benefit.

- Reports from electronic rejected claims are printed and corrected from the report and re-sent.

- All medical claim HCFA 1500 forms have to be sent by paper from Dentrix by billing specialist

- Diagnosis codes are downloaded to the Dentrix system frequently to ensure proper billing

- The billing specialist must check Unpaid Claims reports regularly to detect problems with electronic claims transmissions.

Creating Payment Plans for Patients

- Patients who do not have insurance have a consultation with the billing specialist before they leave Samuels. A payment plan is established with coupons for them to mail in monthly.

- Billing specialist schedules interpreters for non-English speaking patients to be in the room while she explains payment plans to them.

Auditing Accounts

- Because of previous problems that Samuels Sinclair Dental Center had with insurance the billing specialist needs to audit the ledgers continually to correct errors that were made previously. At that time we had over 6000 active patients in our system. This is an ongoing process with the billing department.

Research Accounts

- There are still past due accounts that have to be researched and resubmitted to insurance plans monthly. This work has to be done in a timely manner so the dental center does not lose more revenue.


- The billing specialist advises the staff daily of insurances and what is billable to a patient and if they need to consult with her on any insurance issues they are not sure of when treating a patient.


- The billing specialist maintains generic passwords and ID�s for websites to various insurances to be able to verify and check for frequencies on patients accounts the day before they come in to the dental center. This report is done by the front OSR�s.

- The billing department meets with the manager monthly to go over the previous month�s billing to discuss patient accounts.

Dentrix Enterprise � clinic software

- Attends quarterly meetings along with manager to network with Dentrix clinics in the New England area to establish enhancements to the software and discuss best practices in our software issues.

- Helps manager train staff on new software updates and solve any current problems with software to aid staff.


Other information:

High School Diploma or equivalent.

Completion of formal education and training in ICD-9 & CPT coding anatomy physiology and medical terminology.

Preferred certification as a Registered Medical Coder (CMR) Certified Coding Specialist (CCR) or Certified Professional Coder (CPC or CPC -H).


Two years related experience coding and billing using a hospital online billing system and demonstrated expertise and accuracy of code assignment.


Walking sitting standing throughout the day in clinic setting



Lifespan is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status.   Lifespan is a VEVRAA Federal Contractor.


Location: Rhode Island Hospital USA:RI:Providence


Work Type: Part Time


Shift: 1


Union: Non-Union