TITLE: MEDICAL CODER II

POSITION TYPE: FULL TIME

REPORTS TO: BUSINESS OFFICE MANAGER

FLSA CATEGORY: NON-EXEMPT

DEPARTMENT: BUSINESSS OFFICE

MAIN LOCATION: 3676 PARKER BLVD, PUEBLO, CO 81008

JOB SUMMARY: This position is required to perform all duties of the Medical Coder. This position will be responsible for establishing, maintaining, and enforcing acceptable professional and ethical standards for billing of the Southern Colorado Clinics medical staff according to its policies, procedures, philosophy, and objectives. Responsible for all facets of medical claims billing and accounts receivable management including claims submission, denials and appeals, patient payments, payment plans and outside collections.

DUTIES AND RESPONSIBILITIES

• Accurately code claims (CPT & ICD-10) based on provider documentation.
• Submit initial and corrected claims and follow up on appeals and denials.
• Resubmit insurance claims the have received no response or are not on file and ensure claims are paid and processed according to Clinic contract.
• Assist with error resolution.
• Maintain required billing records, reports, and/or files.
• Post all credit and debit adjustments to patient accounts with strict adherence to the company guidelines.
• Continually work accounts receivable to ensure prompt payment for services rendered.
• Provide customer service both on the telephone and in the office for all patients and authorized representatives regarding patient accounts in accordance with practice protocol.
• Follow-up on all outstanding insurance claims at 60 days from the date of service in accordance with business office protocol with an emphasis on maximizing patient satisfaction and practice profitability.
• Follow-up on all returned claims correspondence, denials, account reconciliations, and rebills.
• Recommend accounts for outside collection when internal collection efforts fail in accordance with billing office protocol.
• Process refunds to insurance companies and patients in accordance with billing office protocol.
• Establish payment plans with patients within approved guidelines.
• Adhere to all practice policies related to HIPAA, CMS Compliance, and OSHA.
• Perform patient education when appropriate.
• Provide front desk coverage as necessary.
• Maintain work area in a clean, sanitized, and organized manner.
• Follows all Infection Prevention policies and procedures.
• Attends annual required company programs and trainings.
• Attends all regular required department and company meetings.
• Maintains strictest confidentiality.
• Performs all other tasks and projects assigned.

REQUIREMENTS

• High School Diploma or equivalent required.
• Billing/Coding Certification required.
• Knowledge of provider health insurance and the health insurance industry.
• Proven experience in healthcare billing and coding and associated regulations
• Proficiency in filing and collecting insurance claims for individual carriers or agencies.
• Knowledge of CPT and ICD-10 coding and clinic operating policies.
• Knowledge of medical terminology.
• Ability to multitask.
• Strong ethical code of conduct.
• Ability to maintain sensitive confidential information.
• Proficiency with computers and EMR software.
• Autonomous, positive mindset and team player.
• Ability to remain motivated with a positive attitude.
• Disciplined, organized, and detail oriented.
• Willingness to learn and adapt.
• Ability to work with all levels of management and staff in a professional capacity.

TYPICAL PHYSICAL DEMANDS

Major activities of this job include sitting for long periods of time, moving from place to place, and light physical effort performed on a level surface. Use of a computer, telephone, writing, and organizational skills. Manual dexterity for use of computer keyboard and calculator, mobility and good vision (includes near acuity and depth perception). May be required to lift and carry items weighing up to 10 lbs., occasionally lift or move up to 100 lbs. with assistance. Requires ability to communicate effectively and have hearing within a normal range. Southern Colorado Clinic will make reasonable accommodations for the known disability of an otherwise qualified individual, unless such accommodations would cause undue hardship to the operation of the Clinic or pose a direct threat to patient or other employees’ health and safety.

TYPICAL WORKING CONDITIONS

Must possess the physical and mental abilities to perform the tasks normally associated with a Medical Coder. The work environment is indoors in an office / medical clinic setting, this is NOT A REMOTE POSITION. Frequent exposure to communicable diseases, toxic substances, ionizing radiation, medicinal preparations, moving equipment, and other conditions common to a medical clinic environment. Requires working under stress in emergency situations, meeting deadlines, frequent interruptions, and occasionally may involve irregular working hours.

JOB TIERS

Coder II = Certified with less than 3 years of experience.

Coder III = Certified with more than 3 years of experience.

Experience must be confirmed via references from past employers. Non-certified coders will not be considered, regardless of experience.

NOTE: Nothing in this job description implies a contract of employment, nor does it restrict management’s rights to assign or reassign duties and responsibilities to this job at any time. This job description is subject to change at any time.