Certified Coder

About Primary Health Solutions

Our Mission

We meet people where they are and partner with them on their journey towards wellness.

Our Vision

The destination for servant leaders to provide comprehensive and exceptional care.

Our Values

R – Respect

I – Innovation

S – Stewardship

E – Excellence 

Billing and Coding Specialist Summary

Responsible for entering/auditing/coding patient services to ensure encounters transfer properly for submission to insurance payers. Analyze coding related claim issues, process gaps and denials to trend feedback for providers by location and/or specialty. 

A Day in the Life

· Review provider documentation (including hospital procedures) and translate services into correct codes. Append payer specific modifiers and claim criteria when applicable. 

· Review incomplete encounters and code based on available documentation in EHR systems.

· Know and understand several different coding systems, including ICD-10-CM, ICD-10-PCS, CPT, Level 1 HCPCS and Level 2 HCPCS. 

· Use computers / billing software to create and bill encounters that generate clean claims.  

· Attend internal meetings relevant to EHR workflows and share best coding practices. 

· Assist Operations when coding guidance is requested for existing or new services. 

· Understand payer reimbursement and PPS visit qualification for Medicare and Medicaid. 

· Trend areas of focus where provider training or re-training is needed. 

· Monitor, trend and resolve tasks related to coding edits, rejections, and denials. 

· Communicate with providers, patients, and insurance payers.

· Review patient accounts and correct any missing or inaccurate information.

· Investigate and appeal claims that were denied incorrectly. 

· Complete coding projects such as quarterly or ad hoc provider chart audits.

· Adapt to updates and changes in billing software.

· Assist with training office staff on billing/coding updates.

· Maintain strict patient confidentiality and information security.

· Investigate insurance fraud and report if found. 

· Performs all other duties and tasks as assigned. 

Supervisory Responsibilities 

This job has no direct reports.

Core Competencies

· Customer Service: Committed to increasing customer satisfaction, sets proper customer expectations, assumes responsibility for solving customer problems, ensures commitments to customers are met.

· Communication: Understand and communicate effectively with others using a variety of contexts and formats, which include writing, speaking, reading, listening and interpersonal skills.

· Dependability: Meets commitments, works independently, accepts accountability, handles change, sets personal standards, stays focused under pressure, meets attendance/punctuality requirements.

· Quality: Is attentive to detail and accuracy, is committed to excellence, looks for improvements continuously, monitors quality levels, finds root cause of quality problems, owns/acts on quality problems.

· Productivity: Manages a fair workload, volunteers for additional work, prioritizes tasks, develops good work procedures, manages time well, and handles information flow.

Success Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education/Experience

· Knowledgeable and experienced with Medical Terminology.

· Multitask oriented, organizational and team skills.

· Proficiency with computers, Microsoft Office 360 (Outlook, Word & Excel), Adobe and medical billing software.

· Knowledge of unfair debt collection practices and insurance guidelines.

· Understanding of primary code classifications: ICD-10-CM, ICD-10-PCS, CPT and HCPCS.

· Communication skills with patients/healthcare companies.

· Basic accounting and bookkeeping practices.

Language Skills

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of cust