Job Description

Summary

To use a knowledge of medical records coding rules, insurance and Federal, State and Municipal regulations and reimbursement rules. To have the ability to communicate clearly with personnel, patients, clients and insurance companies. To maintain and update coding and billing certification requirements

Essential Duties and Responsibilities

These duties and responsibilities described below represent the general tasks performed on a daily basis. Any other duties as needed to drive to the vision fulfill the mission and abide by the values of the organization.

• Attend required hospital-wide orientations, meetings, and in-services
• Demonstrate a commitment to flexible work scheduling when necessary to ensure patient care
• Develop and/or update master file of procedure and diagnosis codes
• Update organization fee schedules as necessary
• Work with other members of the billing and reimbursement staff in identifying and correcting insurance claims
• Assign proper CPT and ICD-10 codes from the patient medical records for proper claims submission
• Process patient Accounts Receivable, insurance carrier Explanation of Benefits (EOB), denials and documentation requests as needed
• Post insurance and patient payments including any pertinent correspondence into the computer system
• Perform internal audits of billing and reimbursement procedures
• Perform internal chart audits for billing and coding accuracy
• Coordinate and cooperate with internal and/or external auditors during billing and organization audits
• Comply with all rules, regulations and procedures of the organization
• Process patient and insurance carrier telephone calls for account inquiries
• Perform any other job duties assigned by the Billing Department Manager or other Managerial Staff

Supervisory Responsibilities

Reports to:

Billing Manager

Supervises:

n/a

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 ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and Experience

Minimum Required Education:

Certified Professional Coder Certificate

Preferred Education:

Associates Degree in Healthcare

Experience:

Previous healthcare billing, coding and follow-up experience, ability to operate copier, FAX machine and computer, must have excellent organizational, communication and interpersonal skills, must have the ability to set priorities and manage varying workload

Certificates, Licenses, Registrations

Certified Professional Coder Certificate required