The Medical Coding and Billing Specialist is responsible for reviewing patient medical records and assign codes to diagnoses and procedures performed to ensure accurate billing to insurance, other third-party payers (such as Medicare or Medicaid) and the patient. Follows role assignments that are in alignment with the Patient Centered Medical Home Standards, and participate in all Patient Centered Medical Home efforts.
Review and ensure that the ICD-10 and CPT coding on encounters are correct and are properly documented in the medical record for a sampling of patient visits each week
Send coding queries to providers as needed to validate the codes and/or clarify documentation in the medical record
Handle information about patient treatment, diagnosis , and related procedures to ensure proper coding
Ensure reimbursement for all procedures
Submit claims to Clearing House
Investigate rejected claim to see why denial was issued
Process payments from insurance companies
Verifies over-payments, collecting data, making adjustments, reversals and clearing up any discrepancies
Review delinquent accounts and perform various collection actions including contacting patients by phone, insurance carriers, correcting and resubmitting claims to other MCOs
Manages rejected billing and re-submission of claims for Medicaid, Manage Care Organizations and third party insurances
Reports trends in claims rejections that may have an impact on maximizing clinic revenue
Serves as the Revenue Cycle Manager’s back-up
Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations
Assist with other revenue cycle tasks and duties as requested by Manager
Other related duties
High School diploma or equivalent, AA degree preferred.
Submit resume and cover letter to include salary expectation.
Near North Health Service Corporation is an Equal Opportunity Employer. The Mission of Near North Health Service Corporation (NNHSC) is to provide access to high quality health care and to improve the health and well-being of the diverse populations and communities we serve. We are a culturally sensitive, patient centered community health center that empowers individuals through education and health prevention, regardless of one’s ability to pay.