Medical Coder / Biller - Full-time - AVALA RH47

Summary

The Medical Coder / Biller role possesses a valid medical coding certification (CPC) and has solid experience in accurately coding surgery-related patient services. The Medical Coder / Biller will perform billing and coding tasks. Experience in surgery coding is a requirement.  Spine coding experience is preferred but not required. 

Essential Duties and Responsibilities

• Review provider documentation for coding appropriateness and accuracy. Codes patient services, enters appropriate CPT codes, and gathers modifiers from supporting documentation.
• Examine information about patient treatment, diagnosis, and procedures to ensure proper coding guidelines are met.
• Follow up on claim status to confirm whether accepted or denied at clearing house level.
• Researches and corrects all rejections at the clearing house level.
• Monitor and advise on how to optimize billing, coding, and collection procedures to improve the efficiency of the billing and collection processes.
• Analyze trends impacting charges, coding, collection, and accounts receivable and advise or take appropriate action to optimize processes and procedures.
• Performs other duties as directed or assigned.

Qualifications

• Certified Professional Coder (CPC or CPC-A) is required
• Minimum 3-5 years of medical coding experience – surgery coding knowledge required; spine coding preferred.
• Advanced knowledge of medical terminology, billing processes, and matching insurance documentation to support the coding process.
• Ability to effectively understand, follow, and communicate oral and written instructions in English. Must read, write, and speak English fluently to ensure clear work-related communication and patient safety.
• Exceptional analytical and problem-solving skills
• Complete understanding of and working experience using various medical billing software and systems

Core Competencies

Action Orientation - Targets and achieves results, overcomes obstacles, accepts responsibility, establishes standards and responsibilities, creates a results-oriented environment, and follows through on actions.

Communications - Communicates well both verbally and in writing. Effectively conveys and shares information and ideas with others. Listens carefully and understands various viewpoints. Presents ideas clearly and concisely and understands relevant detail in presented information.

Creativity/Innovation - Generates novel ideas and develops or improves existing and new systems that challenge the status quo, takes risks, and encourages innovation.

Critical Judgment - Possesses the ability to define issues and focus on achieving workable solutions. Consistently does the right thing by performing with reliability.

Customer Orientated - Listens to customers, builds customer confidence, increases customer satisfaction, ensures commitments are met, sets appropriate customer expectations, and responds to customer needs.

Interpersonal Skills - Effectively and productively engages with others and establishes trust, credibility, and confidence with others.

Leadership - Motivates, empowers, inspires, collaborates with, and encourages others. Builds consensus when appropriate. Focuses team members on common goals.

Teamwork - Knows when and how to attract, develop, reward, and utilize teams to optimize results. Acts to build trust, inspire enthusiasm, encourage others, and help resolve conflicts and develop consensus in creating high-performance teams.

Professional Requirements

• CPC or CPC-A required
• Meets dress code standards and adheres to policies.
• Completes annual education requirements.
• Maintain regulatory requirements
•  Maintains patient confidentiality at all times.
• Reports to work on time and as scheduled, completes work within the designated time.
• Wears identification while on duty, and uses computerized punch time system correctly.
• Represents the organization in a positive and professional manner.
  
• Complies with all organizational policies regarding ethical business practices.
  
• Assists other staff members in performing any duty that enhances the delivery of patient care.
• Other tasks as assigned.

Skills

• Ability to communicate effectively in English, both verbally and in writing.
• Basic computer knowledge.

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. While performing the duties of this job, the employee is regularly required to talk and hear. This position is very active and requires repetitive motions, standing, walking, bending, kneeling and stooping all day. The employee must frequently lift or move items weighing up to 50 pounds.