Responsible for all aspects of coding and billing for inpatient and outpatient claims, including CCM billing. This role supports the revenue cycle by facilitating coding, managing the claims process, handling claim creation and follow-up, and communicating with providers, insurance representatives, and patients regarding coding issues. The position also supports process improvement efforts to maximize revenue and requires an onsite presence at clinical locations.
Requirements & Qualifications
Essential duties
- Perform accurate and timely multi-specialty coding for daily claims submission.
- Prepare and submit clean claims to third-party payers.
- Work with clinical team members on claims appeals, denials, and resolutions.
- Audit daily billing summaries and validate documentation supports services rendered.
- Respond to patient, payer, provider, and staff inquiries related to claims submission.
- Communicate billing and documentation policies, procedures, and regulations to physicians, learners, and other care providers.
- Ensure maximum reimbursement across patient, payer, and special billing arrangements.
- Assist with provider and learner education to support coding quality.
- Participate in clinical huddles, didactics, and other meetings as requested.
- Help implement and maintain billing/coding educational materials and population management training programs.
- Serve as a subject matter expert for billing and coding matters.
- Understand FQHC coverage, coding, billing, reimbursement, Medicare, Medicaid, commercial payer rules, and value-based payment contracts.
- Review and implement changes from payer bulletins.
- Follow coding and billing guidelines and legal requirements to ensure compliance.
- Coach and mentor billing and education teams.
Qualifications
- Associate or bachelor’s degree in a healthcare-related field or equivalent experience.
- Certified Professional Coder (CPC) with 7-10 years of direct professional coding experience.
- CRC and CPCO certifications are preferred.
- Strong knowledge of ICD-10, CPT/HCPCS, medical terminology, and billing processes.
- Knowledge of medical billing/EHR systems, preferably Medent.
- Familiarity with EOBs, EFTs, and ERAs.
- Proficiency with Microsoft Office.
- Strong leadership, problem-solving, organization, and attention to detail.
- Excellent verbal and written communication skills.
Location
Pennsylvania, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
No
Posted
2 years ago