HealthySteps is a unique, evidence-based pediatric primary care program committed to healthy early childhood development and effective parenting so that all children are ready for kindergarten and success in life. This position will work with the HealthySteps National Office Policy and Finance team to determine applicable billing codes and requirements for HealthySteps services. The Specialist will serve as a subject matter expert to the HealthySteps network of sites across the country and provide education, guidance, and technical assistance to HealthySteps sites on reimbursement for billable services at the state-level to promote long-term site sustainability. This individual will also research reimbursement policy changes at the federal and state levels and determine their applicability for the site network.
Essential Duties and Responsibilities
Serve as revenue capture, reimbursement, and billing and coding subject matter expert for HealthySteps National Office and Policy and Finance Team including identifying appropriate codes for billing HealthySteps services
Provide guidance to National Office staff and HealthySteps sites on relevant CPT, HCPCS, and ICD10 content as well as coding requirements related to pediatric, caregiver, parental, and family services in the primary care setting
Work with HealthySteps Policy and Finance Team to determine potential reimbursement and billing options for HealthySteps national site network
Research and interpret changes to insurer, state, and federal guidance on reimbursement and billing and coding related to pediatric and family practice services
Attend seminars and workshops, as applicable, for updates on new pediatric and family practice coding rules and regulations
Develop reimbursement, billing, and revenue capture educational guidance for HealthySteps site network, in collaboration with National Office staff, including creation of state-specific billing and coding toolkits to disseminate to the site network
Assist HealthySteps sites with researching and determining potential billing codes and reimbursement/revenue capture opportunities at the state and site-levels
Work with HealthySteps sites and staff to address ongoing reimbursement questions, provide guidance to avoid common reimbursement errors, and share mechanisms to drive increased revenue capture
Lead educational and technical assistance sessions and webinars, for the HealthySteps site network, to provide reimbursement and billing and coding guidance to assist with funding HealthySteps service delivery
Performs other duties as assigned to ensure the efficient and effective functioning of the project
Essential Skills and Experience
At least 5 years of experience working in revenue capture, reimbursement, and billing and coding in both a health system and payer environment, with pediatric and family medicine experience required
Knowledge of pediatric, behavioral health, care coordination, and infant and early childhood mental health codes, and their respective guidelines, as well as billing for two-generation approaches to care
Demonstrated experience educating clinicians and clinic staff on revenue capture through reimbursement and coding improvements
Knowledge of billing and coding under Medicaid state and federal requirements as well as commercial insurance
Ability to interpret and appropriately communicate federal, state and insurer billing regulations
Experience conducting research on specific topics, synthesizing findings for various audiences and purposes, and presenting research and findings to internal and external stakeholders
Familiarity with billing requirements for federally qualified health centers (FQHCs) a plus
Knowledge of billing for Indian Health Service and TRICARE services a plus
General knowledge of DC: 0-5 a plus
Up to 20% travel may be required
Encourages and practices critical thinking
Is self-reflective and empathic
Recognizes the influence of workplace relationships on outcomes and results
Maintains a respectful and accepting approach to others
Awareness of the influence of the larger context on individual behavior
Collaboratively and creatively supports the work efforts of colleagues at all levels and in all areas of the organization
Works well within a team setting as well as independently
Enjoys presenting to internal and external
Medical coding certification from the American Association of Professional Coders or the American Health Information Management Association
Current on continuing medical coding certification education credits
Physical Requirements While performing the responsibilities of the job, the employee is frequently required to use finger dexterity as well as sufficient hand dexterity to use a computer keyboard and be capable of reading a computer screen. Also, may need to remain seated for long periods of time, have the ability to perform repetitive motions, stand, walk, communicate verbally and hear well enough to detect nuances and receive detailed information. The employee may be required to grasp objects, push or pull objects, bend, squat, reach, or kneel. Vision abilities required by this job include close vision for preparing and analyzing data, and expansive reading. May need to lift up to 30 pounds.
Working Conditions The work conditions described here is representative of those an employee encounters while performing this job. Depending on work location, the incumbent will typically work indoors in a heated and air-conditioned office, with a mixture of natural, incandescent and fluorescent light with low to moderate noise levels or be subject to working conditions conducive to a home office. When travel is expected, the incumbent will be exposed to outside environmental conditions during those times.
ZERO TO THREE: National Center for Infants, Toddlers, and Families is proud to be an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individual with Disabilities
Telecommuting is allowed.
About ZERO TO THREE
Our mission is to ensure that all babies and toddlers have a strong start in life. At ZERO TO THREE, we envision a society that has the knowledge and will to support all infants and toddlers in reaching their full potential.
OUR CORE VALUES STATEMENT
We believe that how we do our work is as important as what we do.
By embracing our values, every member of the ZERO TO THREE community contributes to a healthy and positive culture, a more successful organization, and better outcomes for infants, toddlers and their families.
Passion and persistence in helping infants and toddlers thrive
The centrality of healthy positive relationships, including:
A commitment to family in our work and in staff work-life balance
Consistent and authentic collaboration
Respectfulness, inclusiveness and diversity
The highest standards of excellence in our work, including:
Integrity, openness, honesty and transparency
Opportunities for leadership and professionalism
Evidence-based learning and reflection
The freedom to make and learn from mistakes