Basic Function

Responsible for correctly coding healthcare claims in order to obtain reimbursement from insurance companies and government health care programs.

Primary Responsibilities

Analyze provider documentation to identify diagnoses and assign appropriate codes.
Assign codes for diagnoses, treatments, and procedures according to the applicable classification system.
Review claims data to ensure codes meet legal and insurance requirements and that required authorizations are in place prior to submission.
Evaluate and re-file appeals for patient claims that were denied.
Ensure correct patient allocation is set.
Void duplicate charges or charges entered in error.
Identify and report error patterns.
Notify coding supervisors of missing orders or documentation that needs clarification.
Ensure timely and efficient billing of all electronic claims submissions.
Accurately enter payments and adjustments in the A/R system.
Collect health information documented by medical providers and code it appropriately.
Consult with medical providers for clarification to avoid misinterpretations.
Provide accurate account information to patients regarding their A/R accounts and make corrections as needed.
Comply with HIPAA, federal regulations, and Family Care Health Centers policies.

Contribute to community health activities outside of regular job responsibilities.
Participate in Health Center staff problem-solving groups.
Attend and participate in department meetings as assigned.
Perform other duties as assigned.

Works closely with the Chief Financial Officer, providers, patient account specialists, and senior accountant.
Interacts with accountants at other community health centers and other outside contacts as needed.