We are seeking to hire a certified Coder in Physician Services who will be responsible for coding in-office and out-of-office encounters accurately in accordance with CMS guidelines. They will be responsible for processing and tracking insurance claims from the beginning of the claim at charge entry to the end of the claim at zero balance. They will also be responsible for appling the appropriate diagnostic and procedural codes to individual patient health information for data retrieval, analysis, and claims processing.
1. Coding encounters for all physician and mid-level providers accurately in accordance with CMS guidelines.
2. Researching all information needed to complete the billing process, including getting chart information from physicians.
3. Keying charge information into entry program to produce billing.
4. Processing primary and secondary insurance and disability claims in a timely manner.
5. Tracking submitted claims daily, ensuring that all were received by the insurance carriers.
6. Working electronic insurance rejects daily in order to retransmit with corrected information.
7. Tracking claim statuses and denials.
8. Trouble-shooting claim denials and resubmitting claims in accordance with each insurance carrier’s policy.
9. Recording daily productivity on Excel spreadsheet as assigned.
10. Preparing insurance forms and associated correspondences.
11. Training other staff in proper billing/posting procedures.
12. Working with other staff to follow up on accounts until zero balance.
13. Assisting in error resolution.
14. Following SOX controls and Revenue Cycle Guidelines.
15. Maintaining strict confidentiality related to medical records and other data.
16. Practicing and adhering to the “Code of Conduct” philosophy and “Mission and Value Statement.”
17. Attending all required billing education classes.
18. Other duties as assigned.
1. Knowledge and understanding of organizational policies and procedures.
2. Knowledge and understanding of insurance company policies regarding claim submission
3. Knowledge of current ICD-10, CPT and HCPCS codes.
4. Knowledge of 1995 and 1997 Guidelines for E/M coding.
5. Knowledge and understanding of CCI and NCCI edits.
6. Knowledge of medical terminology and insurance practices.
7. Knowledge of computer programs and applications (e.g. Excel).
8. Knowledge of business office procedures.
9. Knowledge of proper grammar, spelling and punctuation.
10. Skill in gathering, interpreting and reporting insurance information.
11. Skill in trouble-shooting insurance problems and claims.
12. Skill in written and verbal communication.
13. Ability to identify claim problems and recommend solutions.
14. Ability to sort and file insurance forms and associated information.
15. Ability to perform basic mathematical calculations, balance and reconcile figures.
16. Ability to work effectively with patients, employees and the public.