Certified Coder/Medical Biller
La Red Health Center Inc, Georgetown, Delaware, United States – Medical
About this position
Position Title: Certified Coder/Medical Biller
Reports to: Revenue Cycle Manager
Primary Location: Georgetown – the incumbent may be transferred or asked to report to any of LRHC’s locations based on organizational needs.
Wage Classification: Non‑Exempt
Job Summary: The Medical Coder/Biller is responsible for accurate coding, billing, payment posting, and follow‑up of medical claims. This position plays a critical role in ensuring timely reimbursement, compliance with federal and state regulations, and adherence to FQHC‑specific billing requirements, including sliding fee‑scale policies.
Essential Responsibilities: The following duties are not intended as a comprehensive list but provide a representative summary of major responsibilities. Additional position‑specific duties may be assigned by the manager or LRHC Leadership.
Coding & Claims Submission
Review coding denials for incorrect/expired CPT, HCPCS, and ICD‑10 codes in accordance with payer and FQHC guidelines.
Assist providers with correct coding by providing feedback and clarification on documentation and coding requirements.
Identify coding errors, trends, or opportunities for improvement and recommend corrective actions.
Notify the Revenue Cycle Manager of repeated or significant coding errors and participate in corrective action planning.
Prepare, review, and submit clean claims to commercial insurers, Medicaid, Medicare, and other third‑party payors.
Ensure claims are submitted in a timely manner and in compliance with federal, state, and payer regulations.
Supports coding audits.
Payment Posting & Electronic Payments
Ensure accurate posting of contractual adjustments, write‑offs, and patient responsibility amounts.
Work in Clearing House to submit and correct claims.
Balance posted payments against bank deposits and remittance reports.
Research and correct posting errors in a timely manner.
Coordinate refunds and credit balance resolution in accordance with organizational policies.
Post payments accurately from insurance payors and patients into the practice management system.
Download and process electronic remittance advice (ERA) and electronic funds transfers (EFT).
Identify and resolve payment discrepancies, underpayments, and overpayments.
Denials Management & Follow‑Up
Work assigned claim denials, rejections, and unpaid claims, including researching payer policies, eligibility issues, authorization requirements, and coding‑related denials.
Review explanation of benefits (EOBs) and remittance advice to determine denial reasons and appropriate corrective actions.
Correct and resubmit denied or rejected claims in a timely manner to meet filing limits.
Prepare, submit, and track insurance appeals with required documentation and supporting medical records.
Communicate with insurance payors via phone, portals, and correspondence to resolve complex or aged denials.
Analyze denial trends, research root causes, and prepare corrections or appeals as needed.
Follow up with payors to ensure timely resolution and maximum reimbursement.
Work AR aging reports provided by the Revenue Cycle Manager.
Sliding Fee Scale & Patient Accounts
Apply sliding fee‑scale adjustments in accordance with FQHC policies and federal guidelines.
Ensure patient charges and adjustments are calculated accurately based on income eligibility.
Collaborate with front desk and eligibility staff to resolve patient account issues.
Support audits on sliding fee scale.
Compliance & Reporting
Maintain compliance with HRSA, CMS, and payer billing requirements.
Support internal and external audits by providing documentation and billing clarification.
Communicate billing issues, trends, and process improvement opportunities to the Revenue Cycle Manager.
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or competency required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
Certified Professional Coder (CPC) certification.
High school diploma or GED required.
Minimum 10 years of medical coding and billing experience in an FQHC or community health center.
Minimum 7 years of experience working with clearing house systems.
Working knowledge of CPT, ICD‑10, HCPCS, and payer reimbursement methodologies.
Experience in FQHC coding, medical billing, health information management, or related field.
Experience with Medicaid, Medicare (including PPS for FQHCs), and commercial insurance billing.
Experience with electronic health record (EHR) and practice management systems.
Familiarity with HRSA and FQHC compliance requirements.
Education and/or Experience
High School Diploma or GED required.
Language Skills
English proficiency.
Skills and Competencies
Strong attention to detail and analytical skills.
Ability to manage multiple priorities and deadlines.
Excellent written and verbal communication skills.
Ability to work independently and as part of a revenue cycle team.
Proficiency in Microsoft Office, Teams, coding and billing software.
Equipment Operated
Wide range of office equipment. Computer use and proficiency required.
Mental/Physical Requirements
Sitting for long periods while using a computer.
Ability to focus for sustained periods with minimal supervision.
Salary Information
$24 – $26.44 hourly wage.
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