Job Title: Certified Coder/Claims Submission Specialist

Work Schedule:  Full-Time office hours are generally M-F, 8:00 AM to 5:00 PM, with overtime as needed. 

Employment Classification: Non-exempt, Hourly 

Status: Full-Time

Position Summary

The Certified Coder/Claims Submission Specialist is responsible for demonstrating knowledge and application of job duties within scope of practice and functions under the direction of his/her manager(s) and/or Director(s); respectfully interacts with all levels of staff; provides assistance, as needed, during assigned duty hours; participates in department activities; promotes independence; adherence to the attendance policy; encourages socialization; advocates for the quality of life of our patients while maintaining compliance with all applicable laws, regulatory and organizational standards; supports the company’s core values.

Summary of Duties and Responsibilities

• Analyze provider documentation to assure the appropriate Evaluation & Management levels are assigned using the correct CPT code.
• Evaluate medical records for documentation consistency and adequacy.
• Assist billing team to establish the medical necessity of charges.
• Provides feedback to the clinical staff on coding issues and reviewing denials.
• Provide training to each provider regarding errors identified and corrected.
• Monitor and audit proper diagnosis codes with appropriate CPT codes for billing purposes.
• Review appropriate medical codes to all diagnoses or services.
• Participate with other staff to follow up on accounts until account balance is zero.
• Complete coding projects as needed.
• Assist with charge entry in all areas as needed.
• Other duties as assigned.

Abilities, Knowledge and Skills

Effective communication skills to include: 

1. Ability to fluently speak and read English 
2. Ability to read and interpret documents such as safety rules, handbooks, policies and manuals 
3. Ability to communicate effectively, verbally and written, with all levels of staff and patients

Education, Prior Work Experience, Special Skill And Knowledge Requirements

Certified Professional Coding (CPC) certification required

High School Diploma or GED required

Basic Computer Skills-must know Excel

2+ years of experience in ASC coding and insurance billing required

Knowledge of the ICD-10, ICD-9, and CPT-/HCPCS universal coding systems.

Knowledge of coding and clinic operating policies.

Knowledge of insurance carrier coding requirements to ensure proper coding based on license and specialty.

Knowledge of third-party billing procedures across a variety of payer systems.

Well organized with an ability to meet deadlines

Detail oriented

Excellent Customer Service

Strong verbal and written communication skills

Physical Demands and Work Environment

Physical Demands 

The physical demands described, here, are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the physical demands. 

1. While performing the duties of this job, the employee is required to use hands to handle, or feel objects, tools, or controls; reach with hands and arms; and talk or hear. 
2. The employee frequently is required to stand, walk, stoop, kneel, crouch, reach, push, pull, bend and sit. On average, billing staff may be sitting 80% of their shift.
3. The employee must occasionally lift and/or move up to 30 pounds. 
4. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust focus. 
5. Specific communication abilities required by this job include the ability to talk and hear in order to converse with others, discern, convey, express oneself, and exchange information. 

Work Environment

The work environment characteristics described here are representative of those an employee may encounter while performing the essential functions of this job. 

1. The noise level in the work environment is usually moderate; lighting is in the standard range. 
2. The employee is subject to infectious waste, potential exposure to allergens in concentrated forms, diseases and conditions. 
3. 
   

EEOC Compliance

Family Allergy & Asthma provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. 

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Please Complete Survey to be Considered:  https://surveys.cultureindex.com/s/kgvM7SYDhF/102127