General Summary of Duties: Apply advanced coding knowledge to submit claims on behalf of the company for services rendered by providers within the organization as assigned. The Certified Coder will serve as the knowledge base for coding assistance to physician and staff and provide training on new and changing coding policies from government and commercial carriers.

Essential Duties: (This list may not include all of the duties assigned.)

• Apply accurate coding to submit initial clean claims to insure prompt and accurate payment exercising compliance in accordance with CPT, government and carrier policy and guidelines.
• Maintains claim submission and carrier response within timely filing limits set forth by the carrier and/or carrier contracts. Maintains current levels of account aging for assigned offices.
• Maintains productivity and quality standards as set by company.
• Reviews accounts for proper reimbursement from carriers and patients.
• Submits adjustment requests for approval for fully worked claims.
• May contact insurance companies and patients regarding payment in a timely manner.
• May contact insurance companies regarding appeals and reviews of medical claims.
• Determines appropriate coding on denied claims, sends reviews and appeals where necessary.
• Maintains good working relationship with divisions by providing support and feedback by making recommendations for coding and/or billing to physician and/or office management staff. Contacts divisions as necessary to research coding, insurance and billing issues.
• Participates in compliance training for office.
• Maintains patient confidentiality.
• Monitors daily and weekly reports to achieve overall coding and claim oversight.
• Coordinates with the division with respect to bad debt and collection efforts.
• Continuous education in areas specific to industry (coding, billing and insurance contracts) by utilizing bulletins, newsletters, seminars etc.
• May be responsible for payment posting as needed.
• Maintains CEU’s for continued certification.
• Performs other duties as required.

• Knowledge, Skills and Abilities. Knowledge of clinic charging, billing and registration policies and procedures. Knowledge of insurance billing procedures. Knowledge of clinic departments and operational relationships. Skill in defining problems, collecting data, interpreting billing information. Skill in computer applications. Ability to perform mathematical computations and compute ratios and percentages. Ability to work pleasantly and effectively with patients and co-workers. Ability to communicate clearly.
• Education: High school diploma, coding and billing courses helpful.
• Experience: At least one year accounts management/billing experience in a health care organization.
• Certificate/License: Certified Medical Coder

Environmental/Working Conditions: Work is performed primarily in a remote environment with office work as scheduled or as needed. Involves frequent telephone contact with patients. Work may be stressful at times. Interaction with others is constant and interruptive. Contact involves dealing with patients, carriers and company personnel.

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.