<h3>Job Description</h3>
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. 
Must be willing to travel to NYC twice a year for required meetings.
Position Purpose: The focus of this position is to establish processes to respond to ICD-10 coding changes and its effect on inpatient claims payment. Chart review will include DRG pre-payment review, hospital readmission review and outlier payment review.
<ul>
<li>Analyze moderately complex health care information; reviews medical records; integrate medical coding and reimbursement rules; provide pricing guidance.</li>
</ul>
<ul>
<li>Ensure medical coding rules and regulations including compliance requirements are adhered to for the appropriate handling of medical necessity, claims denials, and bundling issues.</li>
</ul>
<ul>
<li>Provide regular reports on project status and progress; report project results to identify coding improvement opportunities.</li>
</ul>
<ul>
<li>Collaborate with other business units to identify and implement process efficiency and quality improvement practices.</li>
</ul>
<ul>
<li>Work with IT resources to implement system efficiencies and configuration enhancements to improve claims processing operations.</li>
</ul>
<ul>
<li>Apply Coding Guidelines as described in the ICD-10 Coding Manual.</li>
<li>Performs other duties as assigned.</li>
</ul>
<ul>
<li>Complies with all policies and standards.</li>
</ul>
Education/Experience: RN Degree. One year experience preferred in hospital inpatient coding. Nursing experience in managed care organization or acute care hospital. For Fidelis Care only: One year of experience in a clinical setting or acute care hospital; RN, PA, MD, APRN, DO or MBBS license required. Coding Credential Required: Valid/Current CPC Certification, through APPC preferred or CIC through AAPC or CCS through AHIMA; RHIA/RHIT Credentials-Preferred. 
Pay Range: $68,700.00 - $123,700.00 per year
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
 Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Sr Certified Medical Coder RN

<h3>Job Description</h3>
Job Description
Local, fast-paced, growing specialty practice looking for a Full-Time Medical Coder / Biller. Northlake Gastroenterology Associates is comprised of 6&nbsp;physicians, 5&nbsp;NPs, 3&nbsp;offices and 2 Ambulatory Surgical Centers. We are continuously advancing and making strides to keep up with the modernization of the medical field and industry standards as a whole.&nbsp;
Experience:&nbsp;Minimum of 5 years of medical billing required, CPC certification required
General skills and knowledge:
<ul>
<li>General experience working with insurance carriers and representatives, patients, and staff on meeting/communicating billing &amp; documentation concerns or requirements for billed services.</li>
<li>Standard industry policy and procedure in a medical office setting (i.e. billing, front desk, eligibility verification, PAs, scheduling, referrals, etc.)</li>
<li>Working reports and queues such as A/R, aging, collections, failed scrub, invalid, rejected, etc.</li>
<li>HIPAA compliance and guidelines</li>
<li>CPT &amp; ICD-10 coding from OV, procedure, hospital consults, anesthesia, etc.</li>
<li>Submitting clean claims</li>
<li>Denial management</li>
<li>Using/Understanding of NCDs, LCDs, CCI Edits, and commercial payer policies.</li>
<li>Understanding of checks &amp; balances.</li>
<li>Problem solving skills are mandatory as our billing department plays a vital roll in day to day management of the practice.</li>
<li>Excellent communication skills are necessary with the ability to discuss claim adjudication processes with patients in a professional manner.</li>
<li>Tasking and clear communication with physicians and clinical staff when necessary.</li>
<li>Exemplary organizational skills.</li>
<li>Ability to follow instructions when given tasks, general instruction, or implementation of new procedures within the billing department.</li>
</ul>
Computer/Technical Skills:
<ul>
<li>Proficiency and experience with Microsoft Word, Excel, and Adobe is required as all are used daily.</li>
<li>Ability to develop/manage office forms, letter templates, and spreadsheets is preferred.</li>
<li>Other general computer skills should be proficient as well.</li>
</ul>
Job Responsibilities:
<ul>
<li>Manage rejected, denied, invalid, failed scrubs within the billed and unbilled claim queues daily.</li>
<li>Work A/R report monthly refiling/analyzing claims data.</li>
<li>Identify and research frequent causes of denials &amp; rejections so that corrective action plans can be implemented.</li>
<li>Work denials &amp; recoupments in a timely manner to prevent exceeded filing limits.</li>
<li>Communicate any issues pertaining to claim denials/rejections with the billing supervisor.</li>
<li>Uses reports that categorize denials to assign tasks or personally work to overturn denials.</li>
<li>Researches rejections included in EOBs for resolution and files appropriately.</li>
<li>Cross training in other positions throughout the business office such as front desk, appointments, procedure scheduling, etc to fill in when needed.</li>
</ul>
Company DescriptionNorthlake Gastroenterology Associates is dedicated to providing the most advanced research and treatment of gastroenterology conditions in Southeast Louisiana. NGA has locations in Hammond, Covington and Franklinton. 
<h3>Company Description</h3>
Northlake Gastroenterology Associates is dedicated to providing the most advanced research and treatment of gastroenterology conditions in Southeast Louisiana. NGA has locations in Hammond, Covington and Franklinton.

Medical Coder / Biller - Full Time

<h3>Job Description</h3>
Job DescriptionCompany Description 
The University of Maryland Medical System (UMMS) is an academic private health system, focused on delivering compassionate, high quality care and putting discovery and innovation into practice at the bedside. Partnering with the University of Maryland School of Medicine, University of Maryland School of Nursing and University of Maryland, Baltimore who educate the state’s future health care professionals, UMMS is an integrated network of care, delivering 25 percent of all hospital care in urban, suburban and rural communities across the state of Maryland. UMMS puts academic medicine within reach through primary and specialty care delivered at 11 hospitals, including the flagship University of Maryland Medical Center, the System’s anchor institution in downtown Baltimore, as well as through a network of University of Maryland Urgent Care centers and more than 150 other locations in 13 counties. For more information, visit <a href="http://www.umms.org" target="_blank">www.umms.org</a>.
Job Description 
I. General Summary
<ul>
<li>Under direct supervision, accurately codes hospital inpatient accounts for the purpose of appropriate reimbursement, research, statistics and compliance to federal and state regulations in accordance with established ICD-10-CM/PCS coding classification systems.</li>
</ul>
II. Principal Responsibilities and Tasks
The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
<ul>
<li>Serves as a clinical coding subject matter expert, and utilizes critical thinking to analyze and evaluate documentation issues with consultation from the medical and clinical staff, and clinical documentation specialists as needed.</li>
<li>Analyzes, codes and abstracts complex inpatient cases such as trauma, rehab, neurology, critical care, etc. utilizing the ICD-10-CM and ICD-10-PCS nomenclature to ensure accurate APR-DRG/SOI/ROM and POA assignment.</li>
<li>Utilizes critical thinking to analyze and evaluate documentation issues with consultation from the medical and clinical staff, and clinical documentation specialists as needed.</li>
<li>Collaborates with other senior coders (and the other coding staff) with sharing coding information and providing coding advice to colleagues regarding complex cases to be coded.</li>
</ul>
Qualifications 
III. Education and Experience
<ul>
<li>High School graduate or equivalent. Formal ICD-10-CM and CPT training Associates or Bachelor’s degree preferred.</li>
<li>Minimum of three years ICD-10-CM/ICD-10-PCS coding and abstracting experience with at a Level 1 Trauma and Rehab hospital or 4 years of experience with coding inpatient hospital medical records required.</li>
<li>One of the following required: Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Inpatient Coder (CIC)</li>
</ul>
IV. Knowledge, Skills and Abilities
<ul>
<li>Strong analytical and organizational skills; filing systems; ability to prioritize workloads; meet deadlines and work effectively under pressure; excellent customer service skills; general office procedures; ability to problem solve and work with minimal supervision; familiar with basic medical terminology; computer experience; typing ability.</li>
</ul>
 Additional Information 
All your information will be kept confidential according to EEO guidelines.
Compensation:
Pay Range:$30.26- $42.37
Other Compensation (if applicable):
Review the 2024-2025 UMMS Benefits Guide
Like many employers, UMMS is being targeted by cybercriminals impersonating our recruiters and offering fake job opportunities. We will never ask for banking details, personal identification, or payment via email or text. If you suspect fraud, please contact us at <a href="mailto:careers@umms.edu" target="_blank">careers@umms.edu</a>.

Senior Inpatient Medical Coder

<h3>Job Description</h3>
Job Description
Remote Medical Biller &amp; Coder (Entry-Level &amp; Experienced)
Company: Rooted Talent Solutions
Location: Remote (Work From Home)
Job Type: Independent Contractor (1099)
Schedule: Flexible 
???? About the Role
Rooted Talent Solutions is actively seeking remote medical billers and coders to join our healthcare support team. This is a remote, independent contractor opportunity involving medical claim processing, coding, and administrative support for healthcare providers.
We’re hiring both experienced professionals and motivated individuals looking to enter the field. If you’re detail-oriented, organized, and eager to work from home, this could be the right opportunity for you.
???? Responsibilities
<ul>
<li>Process and submit medical claims accurately and on time</li>
<li>Assign appropriate ICD-10, CPT, and HCPCS codes</li>
<li>Review documentation for coding compliance</li>
<li>Follow up on denied or unpaid claims as needed</li>
<li>Communicate with providers, payers, or clients when necessary</li>
<li>Maintain HIPAA compliance and data security standards</li>
</ul>
???? Qualifications
✅ Preferred:
<ul>
<li>Experience with medical billing, coding, or claim processing</li>
<li>Familiarity with EHR or billing software</li>
<li>Strong attention to detail and accuracy</li>
<li>Basic understanding of insurance guidelines and terminology</li>
<li>Certifications such as CPC or CBCS are a plus</li>
</ul>
???? Entry-Level Applicants:
If you do not have experience, that’s okay. We will consider highly motivated candidates who demonstrate strong interest in the field. Additional details regarding onboarding and training will be discussed during the interview process.
???? Position Details
<ul>
<li>Location: 100% Remote</li>
<li>Schedule: Flexible – hours vary based on client/project needs</li>
<li>Compensation: Varies depending on experience and client placement</li>
<li>Type: Independent Contractor (1099)</li>
</ul>
???? To Apply
Submit your resume and a short message about your experience or interest in medical billing. Selected applicants will be invited to attend an interview session to learn more about current opportunities and next steps.
???? Rooted Talent Solutions is an equal opportunity contractor network.

Copy of Medical Biller & Coder

<h3>Job Description</h3>
Job Description
This is a remote position.
We are looking for a Professional Billing Coding Specialist to code physician services across multiple specialties, including internal medicine, cardiology, and surgical procedures. This remote position requires expertise in CPT and ICD-10-CM coding for professional services rendered in both inpatient and outpatient settings. Coders will be compensated per chart and must meet productivity and quality benchmarks consistently. 
Key Highlights: 
<ul>
<li>Per-Visit Pay Model: Earn $2.15 per visit. Profee coding each chart may include multiple visits (encounters), with each visit (encounter) represented on a separate line. Team average- 12-13 lines per hour </li>
<li>Transparent Productivity Metrics: Know exactly how much you’ll earn per Visit—track your progress and income goals with clarity. </li>
<li>Flexible Scheduling: Work hours available between 6 AM – 6 PM PST, including weekends. Full-time and part-time options available. </li>
<li>Long-Term Opportunity: This engagement offers stability and continuity for coders who meet performance and quality standards. Many consultants have maintained multi-year relationships. </li>
<li>Independent Work Environment: Ideal for self-motivated professionals with strong communication skills. </li>
<li>Supportive Culture: Benefit from regular feedback, monthly reviews, and educational support provided by our team. </li>
<li>Code professional services for physicians, including E/M visits, procedures, and consultations </li>
<li>Ensure accurate code assignment based on provider documentation and coding guidelines </li>
<li>Maintain productivity goals (average 12-13 visits/hour) and quality scores above 95% </li>
<li>Collaborate with billing and compliance teams to resolve coding issues </li>
<li>Stay informed on specialty-specific coding updates and payer requirements </li>
</ul>
 Requirements
<ul>
<li>Certification: Active AHIMA or AAPC Certification (CPC, CPMA, CCS-P) required. </li>
<li>Experience: Minimum of 2 years of ProFee coding experience across multiple specialties </li>
<li>Technology: Proficiency with EPIC and 3M 360 platforms. </li>
<li>Knowledge: Strong knowledge of CPT, ICD-10-CM, and E/M guidelines </li>
<li>Skills: High attention to detail, analytical thinking, and excellent communication. Proven ability to meet high-volume productivity goals. Experience with remote coding systems and per-chart compensation models </li>
<li>Work Environment: Remote work with flexible scheduling options. </li>
</ul>
 Benefits
Our client offers a competitive benefits package to support the health, well-being, and professional growth of their team. While specific benefits may vary by role and employment type, offerings typically include: 
<ul>
<li>Medical, Dental, and Vision Insurance </li>
<li>Paid Time Off and Holidays </li>
<li>Retirement Savings Plans </li>
<li>Flexible Work Schedules </li>
<li>Professional Development Opportunities </li>
</ul>
More details will be provided during the interview process.

Professional Billing (ProFee) Medical Coder

<h3>Job Description</h3>
Job Description
Title: Medical Coder (On-Site)
Employment Type: Full Time
Work Hours: Monday through Friday
City: Bettendorf
State: Iowa
We care about our employees! We value and respect the talented and committed people that make up our practice. Be a part of an organization that works to make a difference in the lives of its patients by encouraging you to be your best every day. 
Position Responsibilities:
We are seeking a detail-oriented and experienced Medical Coder to join our team in an on-site, in-office capacity. This position is responsible for reviewing electronic medical records to identify and accurately code all services and procedures performed by physicians and medical staff. In this role, you will assign appropriate CPT-4, HCPCS Level II, and ICD-10-CM diagnosis codes in accordance with documented medical conditions and services rendered, identifying and communicating documentation deficiencies to providers, analyzing coding-related claim denials, and collaborating with insurance staff to resolve rejections. This role also involves identifying documentation trends and recommending solutions, while maintaining productivity and accuracy standards. ORA holds all our staff members accountable for providing high-level care, maintaining patient confidentiality, and complying with all HIPAA rules and regulations. 
Requirements:
This position requires a high school diploma or equivalent and completion of a medical coding certificate program. CPC or CCS-P certification and one year of coding experience are preferred. A successful candidate will have a strong knowledge of medical terminology, insurance procedures, and coding guidelines. Excellent communication skills, proficiency with electronic medical records, and the ability to work well within a team and collaborate with medical professionals. 
Benefits:
More information about the benefits offered as part of our employment package with ORA Orthopedics is available here: <a href="https://flimp.live/ORAOrthopedicsBenefitSummary" target="_blank">https://flimp.live/ORAOrthopedicsBenefitSummary</a>. Please note that some benefits are dependent upon the position and employment status held.
The pay range displayed for this position represents the pay range for all positions that are classified in this job grade. Individual pay will depend on a wide range of factors such as candidate skills, experience, qualifications, education, location, licensure, certification requirements, and alignment with company benchmarks. It is not typical for an individual to be hired at or near the top of the range for their position; compensation decisions are dependent on the facts and circumstances of each case.
ORA Orthopedics is the Quad Cities' largest and most comprehensive orthopedic provider, proudly offering an integrated continuum of orthopedic care that includes orthopedic sub-specialty clinics, walk-in care at our Urgent OrthoCARE clinics, diagnostic imaging, physical therapy, outpatient surgery, and more. For more information on our practice, visit our website at <a href="http://www.qcora.com" target="_blank">www.qcora.com</a>. Apply to join our team today!
 Job Posted by ApplicantPro

Medical Coder (On-Site)

<h3>Job Description</h3>
Job Description
Do you speak fluent CPT with a side of sass? Can you handle prickly provider chats with poise, streamline processes, and make overpayment trends tremble? Then you, my friend, are exactly who we need.
Here's the vibe: We're not your average coding operations. We're the ones in the trenches, turning chaos into clarity, and making results art form. You'll be the spark behind smarter recoveries, cleaner audits, better support, and conversations that get results.
What you'll need:
<ul>
<li>Jedi-level resilience when the provider gets spicy</li>
<li>Intuition for what's missing-or what shouldn't be there</li>
<li>Pattern-spotting skills that'd make a data scientist jealous</li>
<li>Confidence that comes with knowing your business operations, consistent follow through and execution of priorities</li>
</ul>
What you can expect:
<ul>
<li>Room to shine and show your strategic flair</li>
<li>A crew that respects your insight (and your memes)</li>
<li>Challenges that keep you sharp and impact that feels real</li>
<li>Opportunity to create workflows, processes, support, and trend management</li>
</ul>
100% onsite in Farmers Branch, TX
CPC designation and associate's degree required; bachelor's degree preferred
Next steps?
Apply, talk, and be ready to be amazed!

Clinic Medical Coder - Farmers Branch, TX

<h3>Job Description</h3>
Job Description
We are currently looking for candidates with experience specializing in the following area: Plastic reconstruction and Breast
Responsibilities:
<ul>
<li>Review and accurately code cases to maximize reimbursement in a timely manner.</li>
<li>Review and accurately code E/M visits and office procedures.</li>
<li>Able to work independently and research coding scenarios.</li>
<li>Coder is responsible for meeting our daily production goal and our quality goal of averaging 95% accuracy rate on a consistent basis.</li>
<li>Attend conference calls as necessary to provide information and/or feedback.</li>
<li>Communicate with leadership on coding or documentation issues/trends.</li>
<li>Stay current on all coding guidelines (to include orthopedic-specific guidelines) and maintain credentials as necessary.</li>
<li>Participate in coding department and education meetings.</li>
<li>Flexible to expand coding skill set into other specialties altogether.</li>
<li>Maintain confidentiality and protect sensitive information.</li>
<li>Other duties as assigned by leadership.</li>
</ul>
Education/Experience Requirements: 
<ul>
<li>High School diploma required. Associates or BS degree preferred.</li>
<li>Successful completion of at least one AHIMA or AAPC certified program with the achievement of the correlating professional credential (CCS, CPC, etc.); active and in good standing. A CPC or CCS-P certification is required. CPC-A is not accepted. Minimum of 3 years physician coding experience (recent hands-on production) in professional general surgery coding &amp; procedural coding in at least one of the following areas: Neurosurgery, General Surgery (SDS), Plastics, Podiatry required with expertise in Breast/Plastic Reconstruction.</li>
</ul>
Benefits
M&amp;D Capital offers our employees a comprehensive benefits package, including health, dental, vision, employee assistance plan, paid family leave, short-term disability and life insurance. We also provide a 401(k) plan with employer match, flexible spending accounts, employee discount program and an employee referral program.
Company DescriptionM&amp;D Capital maintains an exciting and energetic culture with opportunity for personal and professional growth and advancement. We work closely with all our staff in order to enhance their skills and grow the scope of their responsibilities, through training and support from every member of our company up to and including those at the executive level. If you meet the qualifications below, we invite you to join our team. 
<h3>Company Description</h3>
M&amp;D Capital maintains an exciting and energetic culture with opportunity for personal and professional growth and advancement. We work closely with all our staff in order to enhance their skills and grow the scope of their responsibilities, through training and support from every member of our company up to and including those at the executive level. If you meet the qualifications below, we invite you to join our team.

Medical Coder: Plastic Reconstruction/Breast

<h3>Job Description</h3>
Job Description
<ul>
<li>Seeking a Claims Reconsideration Coder for a temporary to permanent hire position with a prestigious insurance company in RI.</li>
<li>This position is immediately available for the successful candidate. Experience is preferred; however, consideration will be given to newly certified applicants who have passed the certification exam and can present their certification number.</li>
</ul>
This is a full-time position working 37 1/2 hours weekly, and offers a comprehensive benefits package when/if hired permanently.
Responsibilities include, but are not limited to:
<ul>
<li>Responsible for all aspects of Claim Reconsideration Requests and Contracted Provider Administrative Appeals including reviewing, resolving, adjusting, and development of written communication to providers</li>
<li>Independently abstract and interpret of all medical notes required to determine if the services billed are supported for reimbursement using current industry standard coding, CMS guidelines, plan benefits, contractual reimbursement terms, and company policies</li>
<li>Communicate adverse determination to Provider via written correspondence</li>
<li>Responsible for identification, review and reporting of inaccurate billing practices and trends gleaned from reconsideration determinations and coding/billing knowledge</li>
<li>Work in conjunction with the Medical Director on issues of medical necessity and resolution</li>
</ul>
<ul>
<li>Responsible for reporting of potentially fraudulent or abusive billing patterns to the Special Investigation Unit</li>
<li>Maintain audit documentation and cumulative reports with prior determinations for utilization as a repository</li>
<li>Continuously maintain repository of periodicals, website links and tools used in making determinations</li>
</ul>
<ul>
<li>Perform any necessary adjustments on the claim(s) affected directly by reconsideration determinations in the Health Rules system</li>
<li>Maintain annual Continuing Education Units (CEU) required to sustain their knowledge and accreditation certificate from the AAPC or AHIMA. This includes remaining up to date on coding changes and guidelines.</li>
<li>Perform other duties and/or special projects as assigned</li>
</ul>
Qualifications Required:
<ul>
<li>Associate’s degree or equivalent, relevant work experience in lieu of a degree</li>
<li>Current certification from the American Academy of Professional Coder’s (AAPC) Certified Professional Coder or American Health Information Management (AHIMA) Certified Coding Specialist</li>
<li>Three (3) or more years of direct application of coding, billing, and reimbursement mechanisms</li>
<li>Three (3) or more years of prior claims processing and/or medical billing experience</li>
<li>Prior experience with claims editing software</li>
<li>Prior experience with claims billing or payment systems</li>
<li>Demonstrated working knowledge of medical record documentation requirements and interpretation as it relates to claim reimbursement</li>
<li>Demonstrated knowledge of NCCI, CPT, HCPC, ICD-10-CM, and ICD-10-PCS coding edits</li>
<li>Knowledge of established norms and guidelines in the industry</li>
<li>Basic understanding of contract implementation and working knowledge of contract language</li>
<li>Experience with Optum Encoder, similar coding software/website</li>
<li>Knowledge of HIPAA standards and CMS guidelines</li>
<li>Excellent ability to effectively prioritize and implement tasks/special projects within deadlines</li>
<li>Intermediate skills working with Microsoft Office products including Outlook and PDF documents</li>
</ul>
The interested candidate must have strong communication skills, be organized, have the ability to prioritize tasks, have problem solving skills, have a positive attitude and enjoy working as part of a team,
Must be able to pass a background check.
For immediate consideration please submit your resume.

Certified Professional Medical Coder (CPC)

<h3>Job Description</h3>
Job Description
ORGANIZATION INFORMATION:
Established in 1984, Equitas Health is a regional not-for-profit community-based healthcare system and federally qualified community health center look-alike. Its expanded mission has made it one of the nation’s largest HIV/AIDS, lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) healthcare organizations. With 22 offices in 12 cities, it serves more than 67,000 individuals in Ohio, Kentucky, and West Virginia each year through its diverse healthcare and social service delivery system focused around: primary and specialized medical care, retail pharmacy, dental, behavioral health, HIV/STI prevention, advocacy, and community health initiatives.
ESSENTIAL JOB FUNCTIONS: Essential functions of the job include, but are not limited to, medical and dental insurance understanding of coordination of benefits, claims processing, and follow up. Utilizing a computer for data entry, conducting research, electronic communications, attending meetings, drafting and distributing reports, interacting with others, reconciling data, creating and updating spreadsheets. Communicating with others is an essential job function.
SALARY: $58,700-$73,300
***MUST BE LOCATED IN OHIO***
BENEFITS:
<ul>
<li>PTO</li>
<li>Vision</li>
<li>Dental</li>
<li>Health</li>
<li>401k</li>
<li>Sick time</li>
</ul>
MAJOR AREAS OF RESPONSIBILITIES:
<ul>
<li>
Review Coding, Auditing, and billing reports; ensure timeliness and accuracy of all claim submissions and billing procedures.
</li>
<li>
Prepare and submit clean claims to various insurance companies to include both paper and electronic.
</li>
<li>
Extensive insurance follow-up and working knowledge of the appeals resolution process is required.
</li>
<li>Working in EMR system's workques to process claims per coordination of benefits</li>
<li>Review billing reports; ensure timeliness and accuracy of all claim submissions and billing procedures.</li>
<li>Responsible for contacting insurance companies and navigating insurance websites in order to secure and expedite payments.</li>
<li>Assisting in payment research in a timely and accurate manner.</li>
<li>Answer billing inquiries from patients, clerical staff and insurance companies.</li>
<li>Identify and resolve patient billing complaints.</li>
<li>Assist with patient inquiries for revenue department</li>
<li>Review assigned workques daily to ensure claims are timely</li>
<li>Evaluate patient’s financial status and rebill claims in conjunction with team and third party billing company </li>
<li>Follows and reports status of delinquent accounts.</li>
<li>Perform various collection actions including contacting patients by phone,</li>
<li>Correcting and resubmitting claims to third party payers as appropriate in conjunction with Epic/Ochin </li>
<li>Participate in educational activities and attends monthly staff meetings.</li>
<li>Maintain strictest confidentiality; adheres to all HIPAA guidelines/regulations.</li>
<li>Perform other duties for Finance Department.</li>
</ul>
EDUCATION/LICENSURE:
· High school diploma, Associate’s preferred
· Medical billing certification or equivalent education on the job, formal education required.
· AAPC or other appropriate Professional Coding Certification required
· CPC, CPA, CPMA or relevant certification
KNOWLEDGE, SKILLS, ABILITIES AND OTHER QUALIFICATIONS:
· Financial management, payment processing, and/or accounting experience, and/or formal training or certification preferred
· Must have strong knowledge of CPT and ICD-10 codes and basic medical terminology skills.
· Experience with EMR (Electronic Medical Record) and medical billing software preferred.
· Knowledge of third-party operating procedures and practices, with the ability to read and process EOB’s.
· Ability to travel to multiple clinics in Ohio for trainings and meetings as needed.
· Proven record of accomplishment of exceeding goals; evidence of the ability of consistently make good decisions through a combination of analysis, experience and judgment; abilities in problem solving, project management and creative resourcefulness.
OTHER INFORMATION:
Background and reference checks will be conducted. In accordance with Equitas Health’s Drug-Free Workplace Policy, pre-employment drug testing will be administered. Hours may vary, including working some evenings and weekends based on workload. Individuals are not considered applicants until they have been asked to visit for an interview and at that time complete an application for employment. Completing the application does not guarantee employment. EOE/AA

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