Key
Analyze patient charts, physician notes and discharge summaries Ensure documentation is complete and accurate before coding Translate diagnoses and procedures into standardized codes using: ICD-10-CM (diagnoses) CPT (procedures) HCPCS (supplies/services) Make sure codes correctly represent services provided Follow healthcare laws and regulations (HIPAA, Medicare/Medicaid guidelines) Company Policies Prevent coding errors that could lead to claim denials or audits Stay updated on coding changes and updates Work with billing teams to submit coded claims to insurance companies Verify claim accuracy to ensure proper reimbursement Fix rejected or denied claims by reviewing and correcting codes Communicate with healthcare providers and insurance companies Protect sensitive patient information Follow strict privacy and data security standards Clarify documentation with physicians when needed Collaborate with billing and administrative teams Regularly update knowledge of coding systems and regulations Maintain certification through continuing education Perform coding audits and compliance reviews Train new coders or staff Specialize in areas like inpatient, outpatient, or specialty coding All other duties as assigned.
Post charges into billing system within 24-48 hours and completes other billing functions under direction of supervisor Identifies possible billing errors that might prevent the claim from being processed on the insurance company level Verifies patient coverage and demographic information, draws conclusions, and corrects billing errors or other Claim issues Contributes to improvement of billing procedures and processes Escalates problem claims to management as required by circumstances Communicate effectively with clinic/administrative personnel, assigned coder and CLT-Team Completes assigned training and education Minimum
High School diploma or GED equivalent Medical billing and coding training program -Certificate or associate degree Required Demonstrates experience with medical billing, CPT and ICD-10 codes, Revenue Cycle Ability to exercise discretion on sensitive and confidential matters Demonstrate ability to communicate effectively on the phone, in writing and via email Demonstrates computer skills with data entry software, Microsoft Word, and Excel Institutional accreditation and degree obtainment will be verified upon hire Knowledge of medical terminology, anatomy, and healthcare regulations insurance, banking, hospital medical office or other experience with extensive customer service contact One or more years of billing and coding experience in medical field- required in the medical field.
Bilingual Preferred