Certified Medical Coder/Biller

NOTE: This is not a Remote position

General Statement of Duties

The Certified Coder is a member of the Billing Team and is responsible for insuring the accuracy and completeness of clinical coding. Also assists with claims submission and follow up, researches claim denials and follows up with insurances and patients. Communicates with patients, insurance companies, and staff to ensure the health center’s billing and collections processes are carried out in accordance with established policies. Overall responsibility is to maximize revenues and cash flow to the organization.

Responsibilities and Essential Functions

Certified Medical Coder

· Review codes for all documented professional services provided Applies CPT, ICD, HCPCS and modifiers following coding guidelines

· New vs Established evaluation and management code selection

· Missing orders for services that are documented but not coded

· Age mismatch on wellness CPT codes and ICD codes

· Other age or gender coding mismatch issues

· Diagnosis resequencing

· Removal of preventative diagnosis codes on problem focused office visits

· Add or remove primary or add on lesion destruction procedure code per the documentation

· Telemedicine coding changes, as required by insurance payer

· Contraceptive method implant/removals coding redetermination

· Provides training to providers and LCHC staff as needed

Billing and Collections

· Monitoring and working all billing work queues; to include coding, researching, correcting claims and trending of coding/billing behaviors

· Reviews future scheduled appointments to ensure that registration and insurances are accurate

· Adheres to official coding guidelines, AMA and CMS

· Keeps abreast of reimbursement reporting requirements

· Fields coding questions and ensures review of patient concerns as well as insurance related inquires on behalf of providers as needed

· Discusses accounts with patients as needed and provides resolution to accounts

· Insurance and patient payment posting

· Refund insurances and patients as appropriate

· Notifies uninsured patients of anticipated charges prior to appointments

· Illustrate knowledge of healthcare industry in areas of coding, revenue cycle, claims and state specific insurance/laws

· Ensures timely charge review/processing of daily submissions

· Assists with manual claim submission

· Research claim denials and follows up appropriately

· Assists with patient payments and payment plans

· Ensures electronic patient accounts are accurate

· Assists in maintaining health center’s fee schedule

· Maintains filing system for all material related to billing and collection functions in accordance with organizational standards

· Participates in staff meetings, trainings, and quality assurance activities as directed

· Performs other duties as assigned

Minimum Qualifications and Other Essential Functions

· Current Medical Coding Certification

· Knowledge of medical insurance billing procedures, including CPT and ICD coding

· Establish and maintain effective and harmonious working relationships with staff, patients, vendors, and the public

· Maintain excellent oral and written communication skills and an ability to practice effective professional communication

· Thrive and promote group cohesion as a team member in a rapidly changing environment

· Follow detailed and written oral instructions

· Multi-task and adjust priorities in a fast-paced environment, while maintaining focus and managing disruptions and/or unexpected needs

· Accept feedback from a variety of sources and constructively manage any conflicts

· Maintain excellent organization skills

· Execute and track detail-oriented projects and deadlines

· Demonstrate professionalism

· Demonstrate good judgement while working independently or as part of a team

· Maintain punctual attendance

· Maintain general computer and keyboarding skills

Preferred Qualifications

· Intermediate or advanced knowledge of Microsoft Office Products: Excel, Outlook, Word, and Power Point

· Knowledge of Federally Qualified Health Centers

· High school graduate or GED

Physical Demands Required to Fulfill Essential Functions of this Position

Employee must be able to: sit or stand for long periods of time; focus on tasks while in an active office environment where conversation and noise is prevalent; operate a keyboard, write, speak, and hear; read small print both on paper and on a computer screen for long periods of time and, occasionally lift up to 20 pounds.

Additional Requirements

· Submit to and pass a drug test

· Successfully complete a criminal background check

· Maintain HIPAA compliance and follow confidentiality policies to protect organizational information

· Foster ethical behavior, cultural sensitivity, and an inclusive environment in accordance with our Standards of Conduct and Respectful Workplace Policies

· Work beyond normal working hours, including weekends, if applicable and when required

Working Conditions

There may be exposure to airborne and blood-borne pathogens, and hazardous materials. This position may include working remotely.

Equal Employment Opportunity Statement

La Pine Community Health Center provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, transgender status, national origin, age, disability, marital status, protected veteran status, or any other characteristic protected by applicable laws. La Pine Community Health Center complies with all applicable laws governing non-discrimination in employment in every location in which the organization has facilities. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, transfers, leave of absence, compensation, and training.

LCHC’s Mission, Vision, and Values

All LCHC employees are required to promote and foster LCHC’s mission, vision, and values.

Mission: We improve lives in our community through accessible and affordable healthcare provided with kindness, integrity, and respect.

Vision: For a healthy community.

Core Values: Respect, integrity, collaboration, professionalism, accountability, and compassion.