Job Description

The Certified Coder is responsible for applying accurate diagnostic and procedural codes (ICD-10-CM, CPT, HCPCS) to patient health records to optimize reimbursement and ensure claims are submitted correctly. They are also responsible for managing and maintaining patient accounts as assigned by the Accounts Receivable Manager. This position works closely with internal and external customers to resolve unpaid claims, insurance discrepancies, and patient balances through timely and accurate follow-up. The goal of this role is to maximize reimbursement, ensure correct insurance payments, and uphold the principles of the “Flawless Reimbursement” system.

RESPONSIBILITIES

Coding

• Review patient records for completeness, documentation accuracy, and proper signatures.
• Apply ICD-10-CM, CPT, and HCPCS codes to ensure accurate claims and optimal reimbursement.
• Analyze provider documentation to assign correct Evaluation & Management (E&M) levels; query physicians when documentation is unclear.
• Correct coding errors using electronic tools (Code Correct, Claims Manager, Blue-E, etc.).and ensure compliance with coding, billing, & payer guidelines.
• Maintain patient accounts, follow up on unpaid claims, and resolve insurance or personal balances.
• Perform audits to ensure coding accuracy and maximize allowable reimbursement.
• Respond promptly to service requests and participate in team initiatives to improve workflow and performance.
• Adhere to organizational behavioral standards, promoting patient satisfaction, teamwork, and quality service.

Patient Accounting

• Process patient payments, refunds, and account adjustments.
• Identify and correct medical coding errors, data-entry mistakes, underpayments, and overpayments.
• Assist patients with billing inquiries, insurance questions, and account discrepancies.
• Communicate with patients via phone, email, or written correspondence regarding overdue balances & collections notifications.
• Ensure accurate insurance payments, follow up on denied or incorrect claims, and resolve payer inaccuracies.
• Perform billing and collection duties as needed to support the Accounts Receivable team.
• Utilize Blue E accounts and other payer portals for verification and follow-up.
• Counsel patients on insurance and billing matters, including pre-certification assistance.

CHARACTERISTICS

• Well-organized and detail oriented.
• Service-oriented with exceptional customer service skills.
• Always maintains confidentiality.
• Strong analytical and problem-solving abilities.
• Excellent time management and prioritization skills.
• Collaborative team player with above-average communication skills.
• Committed to continuous learning and adapting in a fast-paced healthcare environment.

Requirements

QUALIFICATIONS

• High school diploma or equivalent.
• 1–3 years of coding and medical billing experience preferred.
• CCS, CCS-P, or CPC certification, or reasonable anticipated certification date required.
• Advanced knowledge of medical terminology, abbreviations, techniques, and surgical procedures.
• Proficiency in ICD-10, CPT, HCPCS coding, and electronic coding tools (e.g., Code Correct, Claims Manager, Blue-E).
• Understanding of insurance and managed care plans, billing procedures, and reimbursement rules.
• Knowledge of federal and state regulations, third-party payer guidelines, and accreditation standards.
• Strong computer skills, arithmetic ability, and attention to detail.
• Ability to maintain confidentiality and composure in fast-paced, high-pressure environments.
• Strong communication skills, both verbal and written; ability to read, comprehend, and follow instructions.

PHYSICAL REQUIREMENTS

• Sitting: Frequently
• Standing: Occasionally
• Walking: Occasionally
• Carrying/Lifting: Rarely (up to 35 pounds)
• Stooping/Kneeling: Rarely
• Other: N/A