Reporting to the Billing Director, the primary function of the Biller and Coder is to perform accurate medical coding and billing functions to ensure timely and appropriate reimbursement for services rendered to clients in a medical setting. This role requires expertise in assigning correct ICD-10-CM, CPT, and HCPCS codes to diagnoses and procedures, as well as managing the full billing cycle from claim submission through payment posting. The Biller and Coder is responsible for reviewing clinical documentation, verifying insurance coverage, submitting clean claims to insurance carriers, County, State, and Federal agencies, and resolving coding and billing discrepancies in a timely manner. Additionally, this position involves maintaining detailed records of all billing and coding activities, preparing reports on billing trends and outcomes, and collaborating closely with medical staff, providers, and insurance representatives to resolve any issues. The Biller and Coder ensures that all financial transactions are processed efficiently and that all coding practices comply with applicable regulations, contributing to the smooth financial and operational integrity of the medical facility.

•  Reviews medical records and clinical documentation to assign accurate ICD-10-CM, CPT, and HCPCS codes for diagnoses and procedures.
• Performs daily medical chart review and work of billing to ensure timely and accurate claim submission.
• Ensures that all third-party billing is completed accurately and timely.
• Prepares, reviews, and processes claims on a daily basis.
• Reviews EOBs and Remittance Advices (RAs) with outstanding corrected claims reprocessed in a timely manner as required by the payer.
• Responsible for the re-submission of claims for payment.
• Verifies coding compliance with official coding guidelines, payer policies, and applicable regulations.
• Identifies and resolves coding discrepancies or documentation deficiencies through collaboration with clinical staff and providers.
• Attends meetings and trainings as appropriate and assists in compiling reports as needed.
• Performs end of month reports and compiles aging reports.
• Fosters an environment that promotes trust and cooperation among all staff of STP.
• Enforces clinic policies and procedures to ensure that the principles of STP are implemented.
• Maintains confidentiality of all patient and employee information to all except designated employees.
• Informs Clinic Manager of matters of general interest and problem areas as such are determined or discovered.
• Ensures accurate documentation and timely submission of patient records for insurance reimbursement and compliance purposes.
• Coordinates with insurance companies to verify patient coverage and obtain necessary authorizations for treatments.
• Tracks and follows up on denied claims, working with patients and insurance providers to resolve issues and ensure payment.
• Monitors coding updates, regulatory changes, and payer policy changes to maintain billing accuracy and compliance.
• Attends all STP mandatory meetings and other meetings as requested.
• Adheres to HIPAA regulations and other relevant laws to protect patient privacy and confidentiality in all communications.
• Performs other duties as assigned by the executive leadership and administration.

• High school diploma required; Associate's or Bachelor's degree in Health Information Management or a related field preferred.
• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent medical coding certification required.
• Medical billing certification.
• Knowledge of CPT, ICD-10-CM, and HCPCS coding systems and proper form usage.
• Basic computer literacy and arithmetic skills.
• Minimum 2 to 3 years of combined medical billing and coding experience.
• Proficiency in Electronic Health Records (EHR) and practice management software.
• Strong analytical skills with the ability to audit coding accuracy and identify billing discrepancies.
• High level of skill in maintaining calm, professional, courteous and helpful demeanor in times of pressure and stress.
• Skill in making appropriate decisions to benefit patients and meet company objectives.
• Ability to prioritize work and complete it on a timely basis with minimal supervision.
• Ability to follow procedures.
• Ability to deal with change and seek out opportunities to effect change to promote patient care.
• Strong customer service approach to problem solving situations.

Language Requirements

• Spanish speaking, required.