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SUMMARY:
The Coder/Biller will evaluate medical record documentation to ensure completeness, accuracy, and compliance with the International Classification of Diseases Manual - Clinical Modification (ICD-10-CM), and the American Medical Association’s Current Procedural Terminology Manual (CPT).  The Specialist will also provide technical guidance and training on medical coding to staff. The Coder/Biller will process claims, post payments and follow up insurance claims to ensure completeness, accuracy, and compliance. Responsible for communication with patients, financial counseling of patients, and collection of patient’s balances due. To ensure success you must function to a high level of accuracy, be motivated, detail-oriented and have outstanding people skills.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Evaluates EMR documentation diagnostic and procedural codes to ensure it accurately reflects and support the patient visit and the data complies with legal standards and guidelines.
• Provides guidance to staff in resolving issues such as incomplete, ambiguous, or nonspecific documentation and/or codes that do not conform to coding principles/guidelines.
• Interprets medical information to accurately assign the correct billing codes ensuring compliance with medical coding policies and guidelines.
• Knowledge of and compliance with insurance, other payers, and internal guidelines, including Medicare, Medicaid, Worker’s Compensation, Ladies’ First and sliding fee scales
• Review patient charges for accuracy and completeness and obtain any missing information before submission for payment.Prepares and submits clean claims to insurance companies either electronically or by paper.
• Posting of payments and adjustments for patients and third-party payers
• Review accounts for overpayments and prepare refund requests.
• Using the computerized billing software as a tool, follow-up on unpaid insurance claims and patient accounts and perform necessary research and functions towards collection. Reviews insurance EOB’s, inquiries, and denials. Follow up, correction or re-submittal, as needed.
• Answer patient questions regarding charges, payments and adjustments posted to their account
• Provides reports to manager on the number of denied claims and documentation or coding issues.
• Updates procedures manuals to maintain standards for correct coding, minimize risk of fraud and/or abuse, and to optimize revenue recovery.
• Stays abreast of issues and changes in laws and regulations governing medical record coding and documentation.
• Maintain a filing system for all billing related documents to ensure efficient retrieval
• Participate in chart audits with quality assurance.
• Maintains a positive working relationship with all staff in all departments
• Identifies coding training needs, prepares materials, and conducts code training for staff.
• Other duties as assigned.

EDUCATION and/or EXPERIENCE:
High School Diploma, GED, or suitable equivalent. Possession of an Accredited Record Technician’s certification (ART) or Certified Professional Coder designation (CPC) issued by the American Academy of Professional Coders; or two years of experience in medical record coding. An equivalent combination of experience, education, and training may be substituted with the approval of the Accounting Manager.