Medical Coder

Medical Coder

Working title: Medical Coder

Classification title: Medical Coder

Division: Administration

Program: Fiscal Services

Reports to: Medical Billing Manager

FLSA status: Non-Exempt: Full-time

Schedule: Monday-Friday; 8am to 5pm

Wage Range: $24.28 to $32.19 hourly; depending on number of years of transferrable experience and internal equity

RiverStone Health has had a rich history of providing health services to our community since 1974. We strive to build a personal connection with everyone we serve to provide optimal complete solutions, within our realm of expertise, to the variety of challenges faced by our patients, clients, and customers. In our medical and dental clinics, we provide care for 20,000 patients each year, more than half of whom are uninsured and rely on our sliding fee scale. In our medical and dental clinics, we serve all patients, regardless of their ability to pay.

Job Summary: Performs a variety of tasks in the coding and billing. Claims review and submissions as well as technical accounts payable and receivable functions specializing in billing and collections for all RiverStone Clinic Facilities.

Essential Functions/Major Duties and Responsibilities:

• Obtains billing information from medical and dental care providers.
• Analyzes and prepares Medicaid, Medicare, and insurance claims for billing. Verifies claim accuracy and completion.
• Adjusts invoices for patient discounts and amounts based on insurance provider and government program allowances. Prepare and distribute billing invoices at least monthly.
• Performs preliminary "audits" of patient electronic charts to ensure billing information is included and coded properly.
• Establishes and maintains patient financial files. Post charges and payments to patient accounts.
• Posts patient and insurance payments against accounts receivable balances into the electronic health record, eCW. Reconciles differences between actual and expected payments.
• Respond to questions pertaining to patient invoices, sliding fee discounts and payment plans; discusses payment options and sets up payment plans when
• Investigates anomalies, errors, and discrepancies in accounts.
• Develop monthly accounts receivable days tracking systems and closely monitor aging accounts. Include discounts applied and write-off percentages tracking.
• Enters miscellaneous payments made to RiverStone Health into the deposit spreadsheet or other deposit-tracking system.
• Post pharmacy Medicaid payments in pharmacy software.
• Works in Hospital EMR to cross data over to RiverStone Health EMR for provider billing of hospital services.
• Review and provide coding guidance to new providers.
• Processes payment denials and errors and takes appropriate follow-up measures.
• Provides guidance that assists new employees with work tasks to new employees in the same or similar class of positions.
• Be a subject matter expert for providers to utilize when coding and billing questions occur.
• Informs the immediate supervisor and designated others about work progress, present and potential work problems, and suggestions to address problems.
• Responds to citizens' questions and comments with courtesy and in a timely manner.
• Communicates and coordinates regularly with others to maximize the effectiveness and efficiency of interagency operations and activities.
• Attends meetings, conferences, workshops, and training sessions and reviews publications and audio-visual materials to become and remain current on principles, practices, and new developments in assigned work areas.
• Performs other functions as assigned by specific programs.

Non-Essential Functions/Other duties as assigned ?10%:

• Perform other duties as assigned in support of RiverStone Health's mission and goals.

Education and Experience:

• Minimum Qualifications: High school diploma or GED; plus experience with or education of ICD-10 codes.

Required Certificates, Licenses, Registrations:

• Certification by a professional association of medical or dental coders. e.g., American Academy of Professional Coders Certification (CPC), Community Health Coding Specialist (CHCS), American Dental Coders Association (CDC)

Knowledge, Skills, and Abilities:

• Computer literacy including MS Excel and Office Suite and knowledge of office procedures and equipment
• Performs data entry relevant to job duties.
• High degree of detail-orientation
• Knowledge and understanding of protected sensitive patient health information (HIPAA) and confidentiality
• Ability to meet deadlines
• Work collaboratively to contribute to a positive work experience
• Communicate calmly, focused on the issue, and with empathy
• Able to perform each essential duty satisfactorily.

Customer Service Excellence:

• Doing things right the first time
• Making people feel welcome
• Showing respect for each customer
• Anticipating customer needs and concerns
• Keeping customers informed
• Helping and going the extra mile
• Responding quickly
• Protecting privacy and confidentiality
• Demonstrating proper telephone etiquette
• Taking responsibility for handling complaints
• Being professional
• Taking ownership of your attitude toward Service Excellence.

Supervision:

• None

Physical Demands and Working Conditions:

• Work is mainly performed on a computer up to 8 hours per day.
• Work is performed in an office environment and requires the ability to operate standard office equipment and keyboards. Must have the ability to lift and carry a laptop and other small items, to walk short distances, and drive a vehicle to satellite locations and conferences.
• Ability to see details near and far, recognize color differences, and focus on fine details like small print and/or instruments required.
• Create and maintain a safe/secure working environment by adhering to safety, security, and health requirements. Integrates injury, illness, and loss prevention into job activities by attending any necessary training and implementing best practices.

Freedom to Act & Decision Making:

• Limited discretion: actions subject to regulations, contract requirements, generally accepted accounting principles and supervision.

Communications & Networking:

• Respond effectively during tense / emotional conversations with patients or their family members and payors.
• Responsible for maintaining confidentiality and sharing only information relevant to inquiries
• Professional communication style with payors, insurers, and patients

Budget & Resource Management:

None

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.