JOB SUMMARY
The Coder/Biller is responsible for all aspects of the coding and billing of all inpatient and outpatient claims. The Coder/Billing Specialist, a key position in the Revenue Cycle, facilitates the coding as well as manages the claims process, including accurate and timely claim creation, follow-up and correspondence with providers, insurance inquiries and patients. The incumbent will assist in the clarification and development of process improvements and inquiries in order to maximize revenues.
REPORTING RELATIONSHIPS
The position reports to the Director of Revenue Cycle.
Required Skills
ESSENTIAL JOB DUTIES AND FUNCTIONS
- Ability to accurately and timely perform multi-specialty coding for claim submission.
- Prepares and submits clean claims to third party payers either electronically or by paper.
- Follows coding/billing guidelines and legal requirements to ensure compliance with federal and state regulations.
- Responsible for ensuring all new residents and providers are oriented to coding, billing, and documentation compliance.
- Responsible for the continuing coding, billing, and documentation education for all providers and residents.
- Understands the considerations of coding in Value Based payment contracts.
- Performs and monitors all steps in the billing and coding processes to ensure maximum reimbursement from patients, government and commercial payers as well as from special billing arrangements.
- Understands Medicare, Medicaid and other commercial payer rules and regulations applicable to billing/coding. Updates business office staff, clinics, residents, and faculty of changes.
- Work closely with team members regarding claim appeals, denials, resolution, and education.
- Responsible for reviewing and implementing changes from payer bulletins.
- Responsible for educating all residents and faculty regarding coding changes.
- Work with government and commercial payers regarding issues with claim submission.
- Respond to account inquiries from patients, payers, providers, and/or other staff as requested.
- Use online healthcare databases and other resources for verification and claim status.
- Deliver the highest quality service to internal and external customers.
- Assist other members of the team with projects as needed.
- Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
- Other duties as assigned by management.
Required Experience
QUALIFICATIONS
- High School Diploma/GED
- Must be a Certified Professional Coder with 2-3 years minimum direct professional coding experience.
- Must have strong knowledge of all guidelines for ICD-10, CPT/HCPCS codes, medical terminology, and billing processes.
- Knowledge of Medical Billing/EHR (Electronic Health Records) systems preferably Medent and Microsoft Office.
- Knowledge of EOBs, EFTs and ERAs.
- Must possess team leadership skills and have a positive disposition.
- Must be focused, self-directed, organized, and have demonstrated problem-solving abilities.
- Accurate and precise attention to detail.
- Excellent verbal and written communication skills.
PREFERRED QUALIFICATIONS
- Certified Professional Coder-CPC
- Certified Risk Adjustment Coder-CRC (not required but a plus)
- Certified Biller
- FQHC Billing