Job: Certified Medical Coder

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Job Description

Job Title:                     

  Certified Medical Coder

Reports To:                   

Coding & Credentialing Supervisor

Job Summary:                    

To timely and accurately bill insurance and patients for all services rendered by providers.

                                                                                                                                                                                                                               

Qualifications and Requirements:

To perform this job successfully, and individual must be able to perform each essential job duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  This job description in no way implies that these are the only duties to be performed and may be modified, interpreted and/or applied in any way as necessary. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

 

Essential Job Duties:

  • Provides coding and billing support.
  • Utilizes advanced, specialized knowledge of medical codes and coding procedures to assign and sequence appropriate diagnostic/procedure billing codes, in compliance with third party payer requirements.
  • Provides appropriate group training and education on current and future coding guidelines based on group findings and industry trends.
  • Researches and resolves coding projects as assigned.
  • Performs ongoing analysis of medical record charts for appropriate coding compliance.
  • Meets daily production goal and quality coding goal of 95% average accuracy rate on a monthly basis.
  • Attends conference calls and weekly billing meetings to provide information related to Coding and Compliance.
  • Performs all billing tasks necessary to efficiently and accurately collect all payments earned for the services rendered by providers.
  • Processes and submits all charges daily for services rendered.
  • Corrects and resubmits all charges filtered and held by the clearing house.
  • Processes all payments received by insurance and patients on a daily basis.
  • Makes appropriate and accurate adjustments to patient accounts for payments provided per contractual agreements with insurance companies and as directed by supervision.
  • Investigates and gathers appropriate information; resubmits denials in a timely manner.
  • Follows-up on outstanding accounts receivable from all insurance companies.
  • Processes and submits patient statements.
  • Sets up payment plans with patients for self-pay balances.
  • Makes appropriate adjustments to patient accounts for timely payment incentives.
  • Performs other duties as assigned from billing supervisor and/or business office manager.
  • Communicates with patients, payers and CCHCI staff.
  • Communicates with insurance companies to ensure efficient processing of claims and resubmissions
  • Communicates with clearing house to ensure all charges are submitted accurately.
  • Communicates with patients regarding questions or grievances of their statements.
  • Communicates with Health Center Management to assist in addressing unbilled encounters and un-submitted charges and find answers to any of their billing related questions.
  • Develops and improves Billing skills.
  • Participates actively in routine staff meetings.
  • Participates in training related to documentation, coding and billing compliance and updates to the Practice Management Software.
  • Participates in collaborative meetings/trainings as available and necessary.
  • Improves development through internal and external trainings provided.
  • Seeks opportunities for growth and advancement within the department.

Required Education, Experience, Certificates & Licenses:

  • High School diploma or GED.
  • Minimum one year experience in medical billing preferred.
  • Must be a Certified Profession Coder (CPC) or Certified Coding Specialist-Physician (CCS-P).

 Required Language Skills:

  • Ability to comprehend and compose effective instructions, correspondence and communications in English in both oral and written format.

 Physical Requirements:

  • Ability to occasionally exert enough force to move objects weighing up to 10 pounds.
  • Ability to continuously remain in a stationary position.
  • Ability to occasionally move about inside the work place to access files, office machinery, etc.
  • Possesses hand-eye coordination and manual dexterity necessary to constantly operate computer, telephone, and other office machinery.
  • Possesses close visual acuity necessary to accurately record and view information on a computer monitor, handwritten and typed documents.
  • Ability to discern the nature of sounds at a normal spoken volume.

 Other Required Knowledge, Skills, and Abilities:

  • Ability to add, subtract, multiply and divide in all measure, using whole numbers, common fractions and decimals.
  • Ability to compute rate, ratio and percent.
  • Ability to skillfully gather and analyze data.
  • Ability to perform variety of assignments requiring independent judgment.
  • Ability to deal with challenges involving one or more variables in routine situations.
  • Knowledge of billing, medical records, health plans, and community health centers preferred.
  • Thorough knowledge of ICD, CPT, and NDC codes.
  • Knowledge of HIPAA and Corporate Compliance rules and regulations.
  • Computer literacy required with proficiency in Microsoft Excel.
  • Thorough knowledge of Practice Management Software preferred.

 Work Environment & Conditions:

  • Work environment is usually typical of an administrative office setting with no substantial exposure to adverse environmental conditions.
  • Frequently, work will be performed remotely and may include extended hours including early mornings, evenings, and weekends.