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Interprets and assigns correct procedure and billing codes to patient claims for processing. Ensures the procedure codes and modifiers are correct to return accurate reimbursement and ensures compliance.

• Ensures compliance with state and federal regulations and insurance carrier contracts by collaborating with clinical staff to ensure accurate and complete coding for patient visits.
• Processes patient insurance claims by reviewing the charges and ensuring the proper insurance information is provided to the insurance carrier. Corrects any claims and advises leadership staff of any steps to be taken to remedy problems.
• Collaborates with patients and insurance carriers to resolve claim rejections or claims that have been pended for payment.
• Collaborates with leadership staff, and clinical staff in the correct procedure codes to be utilized for maintaining compliance with payer reimbursement policies and governmental regulations.
• Applies payments to the correct patient account. Utilizes the insurance carrier’s payment records to create the deposit for the business office cashiers and ensures the payments and deposit are in balance.
• Responds to questions from patients and insurance carriers regarding their current bills.
• Provides training and direction for coding guidelines and coding compliance to department and clinical staff.

Minimum qualifications based upon job documentation and industry best practices. Any current employees not meeting these qualifications will be grandfathered until they move to a different job.

• High school diploma or equivalent.

• Three years' relevant experience.
• Experience with medical coding and medical insurance.

• Certified Professional Coder.

Office or other indoor work with minimal physical demands such as occasionally lifting or moving materials less than 25 pounds.

Work is generally performed in a well-lit, temperature-controlled indoor environment with occasional exposure to the outdoors or any number of elements.

Revised: 2023-12-05