The Coder/Biller will assist with the coding, analyzing and abstracting of all medical encounters. Coding is performed in a timely manner utilizing ICD, CPT and HCPC coding guidelines and in accordance with known laws and regulations associated with medical coding. Assist with outside clinics/hospitals/patients with billing questions. Assist with monthly insurance verification. Prepare and send medical insurance claims. Assist Medical Biller with rejections and other claim issues. Backup the medical biller.

Job Qualifications:

• Possession of a high school diploma or GED certificate
  • Medical terminology, coding, insurance AA degree or coding certification. Ex: AAPC’s CPC.
  • Minimum of verifiable two years coding experience in a primary care clinic
  
  Job Knowledge, Skills and Abilities:
• Human anatomy and physiology and its interaction with medical terminology;
  • ICD, CPT and HCPC coding principals necessary to code for family practice;
  • Understanding of HIPAA rules and regulations and the necessity to maintain confidentiality.
  • Skills to use independent judgment while assisting in the coding process and awareness to interact in a proactive and positive way with providers.
  • Skills necessary to use the phone and provide excellent customer service while communicating with others;
  • Skills in using ten key and computer
  • Ability to handle multiple concurrent tasks and maintain orderliness and priority to those being resolved;
  • Ability to train others in essential duties and responsibilities.
  • Understanding the billing cycle from entry through payment.
  
  Licensure and Credentials:
• Medical coding certification
  
  Functions and Responsibilities:
• Review medical encounters coded by providers for accuracy and completeness prior to approving the encounter for billing.
• Interact directly with office personnel and/or providers for clarification of documentation needed for coding and billing. Develop methodology to track coding discrepancies for feedback.
• Interact with office personnel and/or providers to ensure all encounters and supporting documentation are collected and processed by billing department within established time frames.
• Create and submit electronic and paper insurance claims using computerized practice management system, ensuring that claims are submitted accurately and within timely filing requirements specific to each insurer.
• Review rejected claims and resubmit with corrections as needed.
• Assist the medical support staff in obtaining insurance pre-authorization when required in advance of performing the procedure.
• Assure that established policies, procedures, objectives, HIPAA, Compliance Plan and state and federal rules and laws are understood and followed.
• Attend Compliance Committee, QI, and Staff Meetings.
• Assist outside clinics/hospitals with billing questions, etc.
• Acquire and maintain BH and AODA Prior Authorizations.
• Assist with 304B Insurance and Vaccine Audits (insurance and billing part)
• Assist with patient billing inquiries, payments and payment plans as needed.
• Run reports as needed to complete daily, weekly and EOM billing/coding tasks.
• Processing Sliding Fee Applications as needed.
• Train appropriate personal on billing system.
• Assisting Manager/Supervisor with special projects as requested.
• Regular, punctual attendance is an essential function of the job.
• Perform other related duties as assigned, requested, or required.