Job Description

Job Description

Job Description

Description:

Position Summary:

The Certified Medical Coder represents Roots Community Health Center, working as part of a team in a highly visible setting. This position provides support to the Director of Billing, Billing and Coding Administrator. This position works in collaboration with the providers, billing specialist and finance team, using efficient medical coding. The Certified Medical Coder provides coding audits of all billing providers within the practice based on documentation guidelines, Medicare Guidelines and coding initiatives. As the coder audits and interprets patient medical records, transcriptions, test results, and other documentation, we'll rely on the coder to ask questions, make coding recommendations, research billable procedures and codes — all to ensure a smooth billing process. This is a 6-month temporary position.

Duties and Responsibilities:

• Code office visits and procedures using CPT, ICD-10 codes
• Audit and review coding (CPT, ICD-10) physician notes in the EHR
• Manage Coder Correct/ Super Coder Codify Platforms (AAPC)
• Make coding recommendations; working with providers to ensure accuracy using billing/payer guidelines.
• Educate providers on coding policies and guidelines, medical necessity criteria, programs correct billing methods and procedure codes by written and verbal communication
• Correspond or meet with providers to resolve billing practices
• Audit documentation to ensure it supports complete, accurate and compliant billing with both CMS and payer requirements
• Assist practice physicians and managers with all coding errors, denials, or issues encountered in the billing process
• Monitor charge review queues to ensure that all accounts flow through to billing appropriately
• Submit all charges into billing EHR system AdvancedMD for claims processing
• Act as liaison between billing department and clinic management/physicians
• Translate written policy interpretation into CPT, HCPC, ICD-10 codes for input into systems
• This position is responsible for ensuring compliance with all aspects of applicable regulations, payer billing guidelines.
• Identify specific billing and reimbursement projects as they arise
• Conduct research coding on denied claims and take steps toward resolution
• Correct coding errors in coordination with the billing specialist
• Reviews insurance plans and carrier information for appropriate coding regulations per payer contracted services
• Verify insurance information/PCP assignment
• Ensure/verify the accuracy of patient demographics and insurance information in Electronic Health Record
• Report trends and denial patterns to the Director of Billing
• Participate in internal chart audits, billing audits, and other compliance programs
• Makes recommendations for policies and procedures relating to payer billing guidelines
• Attending Billing and Interdepartmental meetings.

Competencies:

• High School Diploma or GED, Billing/Coding Certification
• Must have experience working in non-profit organization or a community clinic preferred, but not required.
• Certification in medical billing/coding
• Minimum 1 years’ experience performing medical billing, claims review
• Minimum 1 years’ experience with claims follow-up from physician office, third-party setting
• Familiarity with medical terminology and the medical record coding process
• In-depth knowledge/ awareness of all areas related to Payer-specific (Medicare Medi-Cal Medicaid and/or Private) Claims and how they interrelate
• Knowledge of principles methods and techniques related to compliant healthcare billing/collections - Familiarity with Payer-specific (Medicare Medi-Cal Medicaid –CalAim, Private) Claims management
• Previous experience with either Electronic Health Record and Practice Management Systems
• Full understanding of insurance denials, EDI coding rejections and exclusions
• Previous experience with HCFA 1500 claim forms and electronic billing.
• Interest/experience working with low-income communities of color
• Excellent written and verbal communication skills
• Solid organizational skills including attention to detail and multi-tasking skills.
• Demonstrates ability to manage time efficiently and multi-task effectively.
• Clear and effective external and internal, verbal and written, communication skills.
• Strong critical thinker and problem solver
• Excellent team-player
• Ability to work with patients from different backgrounds (culture competency)
• Ability to communicate clearly and respectfully with co-workers and clients
• Strong working knowledge of Microsoft Office (Word, Excel, PowerPoint)
• Ability/willingness to learn Electronic Health Records Insight reporting

Roots Community Health Center is proud to be an Equal Employment Opportunity/Affirmative Action Employer and values diversity of culture, thought and lived experiences. We seek talented, qualified individuals regardless of race, color, religion, sex, pregnancy, marital status, age, national origin or ancestry, citizenship, conviction history, uniform service membership/veteran status, physical or mental disability, protected medical conditions, genetic characteristics, sexual orientation, gender identity, gender expression regardless of physical gender, or any other consideration made unlawful by federal, state, or local laws. Roots uses E Verify to validate the eligibility of our new employees to work legally in the United States.

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