Coder - Inpatient
Medical coder job in Atlanta, GA
Note: If you are CURRENTLY employed at Children's and/or have an active badge or network access, STOP here. Submit your application via Workday using the Career App (Find Jobs). Work Shift Day Work Day(s) Monday-Friday Shift Start Time 7:00 AM Shift End Time
3:30 PM
Worker Sub-Type
Regular
Children's is one of the nation's leading children's hospitals. No matter the role, every member of our team is an essential part of our mission to make kids better today and healthier tomorrow. We're committed to putting you first, and that commitment is at the heart of our company culture: People first. Children always. Find your next career opportunity and make a difference doing what you love at Children's.
Job Description
Provides accurate and timely assignment of appropriate ICD-10 diagnostic and PCS procedural codes on the medical records for the purpose of collecting and indexing quality health information for inpatient hospital encounters.
Experience
* 3 years of experience in a hospital inpatient setting
Preferred Qualifications
* No preferred qualifications
Education
* High school diploma or equivalent
Certification Summary
Minimum of one of the following:
* Registered Health Information Technologist (RHIT)
* Registered Health Information Administrator (RHIA)
* Certified Coding Specialist (CCS)
* Certified Inpatient Coder (CIC)
Knowledge, Skills, and Abilities
* Demonstrated knowledge of medical terminology, anatomy and physiology, pharmacology, coding guidelines, and computers
* Proven detail orientation and good problem-solving related to coding
Job Responsibilities
* Reviews the medical record, identifies the diagnoses and procedures, and assigns ICD-10-CM diagnosis and ICD-10 PCS procedure codes for inpatient accounts.
* Abstracts diagnostic and PCS procedural codes and other pertinent data into the network system as defined in policy and procedures.
* Reviews/monitors assigned work queues and missing documentation encounters as needed, and codes and abstracts any accounts that were missed.
* Provides information on specific problem accounts to the Coding Supervisor.
* Other duties as assigned.
Children's Healthcare of Atlanta is an equal opportunity employer committed to providing equal employment opportunities to all qualified applicants and employees without regard to race, color, sex, religion, national origin, citizenship, age, veteran status, disability or any other characteristic covered by applicable law.
Primary Location Address
Used for remote worker assignment
Job Family
Coding
Certified Medical Coder
Medical coder job in Marietta, GA
Job DescriptionDescription:
The Certified Medical Coder is responsible for analyzing medical records and identifying documentation deficiencies. They serve as subject matter experts for other coders within the billing department and review documentation to verify diagnoses, procedures, and treatment results.
JOB RESPONSIBILITIES
· Communicate effectively with individuals at all levels of the organization, demonstrating strong written and written communication skills.
· Perform CPT and ICD-10 coding under the direction of the Coding Lead and Revenue Cycle Manager, ensuring accuracy and maximum reimbursement.
· Apply knowledge of anatomy, physiology, disease processes, medical terminology, coding guidelines for outpatient and ambulatory surgery, and documentation requirements.
· Work both independently and as part of a team, demonstrating strong attention to detail and process orientation.
· Manage multiple tasks, organize and prioritize work assignments, and maintain accuracy under pressure.
· Review and code both electronic and paper medical records.
· Verify the completeness and accuracy of diagnosis, procedures, evaluations, and management components in medical records.
· Review principal diagnoses, co-morbidities, complications, therapeutic and diagnostic procedures, supplies, materials, injections, and drugs using ICD-10, CPT, HCPCS (all levels), and other coding systems as required.
· Conduct quality assurance checks on data prior to transmittal, correcting errors as needed.
· Analyze medical record documentation for consistency and completeness, using established criteria and regulations for coding purposes.
· Ensure that all documents in the medical record contain authorized signatures and accurate patient identification, verifying that the diagnosis and treatment are appropriately documented.
· Meet and exceed productivity goals set by the Coding Lead and department manager.
· Ensure accurate and appropriate sequencing of ICD, CPT, and HCPCS codes and modifiers according to official guidelines.
· Perform additional duties as assigned.
Requirements:
KNOWLEDGE
· Working knowledge of medical billing practices.
· Familiarity with payers, payer polices, and payer engines.
· Knowledge of HIPAA requirements regarding patients and medical records.
· Understanding of medical terminology, basic anatomy, and physiology.
SKILLS
· Proficient in computer skills, 10-key, and other office hardware.
· Strong mathematical skills.
· Excellent written and verbal communication skills.
· Initiative to provide high-quality services and improve practice efficiency.
· Ability to maintain positive working relations with co-workers.
· Effective time management and organizational skills.
ABILITIES
· Ability to interact professionally and courteously with patients, effectively communicate with both patients and vendors, and remain calm under stress.
· Ability to understand and interpret policies and regulations.
· Ability to prepare documents in response to complaints and inquiries.
· Ability to examine documents for accuracy and completeness.
MININUM QUALIFICATIONS
· Certified Professional Coder (CPC) certification required.
· Minimum of two years of practical coding experience; previous dermatology experience is a plus but not required.
· High school diploma or equivalent required.
· Proficient in MS Office (Word, Excel, PowerPoint)
· Knowledge of Medicare Documentation Guidelines.
· Experience in Evaluation and Management (E/M) coding.
· Proficiency in ICD-10 and CPT/HCPCS coding rules.
· Knowledge in using practice EMR, specifically EMA, is a plus.
ADA Requirements: Candidates must be able to perform the essential functions of the position with or without a reasonable accommodation.
Physical Requirements: Tasks require the ability to exert light physical effort in sedentary to light work, which may involve some lifting, carrying, pushing, and/or pulling of objects and materials of light weight (5-10 lbs). Tasks may also involve extended periods of time at a keyboard or workstation.
Work Environment: Essential functions are regularly performed without exposure to adverse environmental conditions.
Medical Coding specialist
Medical coder job in Tucker, GA
Join Our Team as a Medical Coding SpecialistJob Description
CarePerks LLC, a leading healthcare organization in Tucker, GA, is seeking a detail-oriented and experienced Medical Coding Specialist to join our team. As a Medical Coding Specialist, you will play a crucial role in ensuring accurate patient records and billing processes within our organization.
Key Responsibilities:
Assigning appropriate medical codes to diagnosis and procedures
Reviewing patient information for accuracy and completeness
Ensuring compliance with all coding guidelines and regulations
Communicating with healthcare providers to clarify documentation
Resolving any coding-related denials or discrepancies
Qualifications:
Minimum of 2 years of medical coding experience
Certification in medical coding (e.g. CPC, CCS)
Proficiency in ICD-10-CM and CPT coding
Strong knowledge of medical terminology and anatomy
Excellent attention to detail and organizational skills
If you are a dedicated Medical Coding Specialist looking to make a meaningful impact in the healthcare industry, we invite you to apply for this position at CarePerks LLC.
About CarePerks LLC
CarePerks LLC is a trusted healthcare organization based in Tucker, GA, dedicated to providing high-quality and compassionate care to our patients. Our team of healthcare professionals works tirelessly to improve the health and well-being of those we serve. At CarePerks LLC, we are committed to excellence in all that we do, and we value integrity, respect, and teamwork in our daily operations.
#hc181434
Medical Coder
Medical coder job in Newnan, GA
Job Description
A Medical Coder for WellStreet Urgent Care is responsible for supporting all aspects of the Revenue Cycle for our Urgent Care Centers.
Responsibilities • Coding for our Urgent Care Centers using our internal software
• Knowledge of ICD-10 Coding and compliance
• Experience using an encoder
• Setting up insurance plans within our software
• Working with the Revenue Cycle Management to identify & resolve issues related to coding and the process flow
• Interfacing with clinic staff on billing & coding issues.
• Comply with all legal requirements regarding coding procedures and practices
• Conduct audits and coding reviews to ensure all documentation is accurate and precise
• Assign and sequence all codes for services rendered
• Collaborate with billing department to ensure all bills are satisfied in a timely manner
• Communicate with insurance companies about coding errors and disputes
• Contact physicians and other health care professionals with questions about treatments or diagnostic tests given to patients regarding coding procedures
• Adhere to productivity standards
Minimum Qualifications
• 3+ years of experience in medical billing
• Epic experience required
• Urgent Care and Occupational Health Billing experience is a plus
• High School diploma or equivalent
Required Skills
• Active CPC, RHIT, CCS or COC Certification
• Knowledge of insurance payers, insurance verification, the AR/revenue billing lifecycle and appealing denied claims
• Excellent Computer skills - expertise in MS word suite including Word, Excel and PowerPoint. Experience in using one or more Practice Management Systems/Billing Software Energy, enthusiasm and the ability to work under pressure in a high volume, fast paced, unstructured start-up environment
• Ability to work within a team environment and maintain a positive attitude
• Excellent documentation, verbal and written communication skills
• Extremely organized with a strong attention to detail
• Motivated, dependable and flexible with the ability to handle periods of stress and pressure
• All other duties as assigned.
WellStreet Urgent Care is committed to providing the highest quality patient and customer care. In addition to the above requirements, WellStreet is looking for team members with the following qualities: • A positive attitude toward patients, families, and coworkers. • Willingness always to go the extra mile to create an outstanding experience for customers and to train and lead the center team to do the same. • A desire to work in concert with others in an upbeat and supportive atmosphere while reinforcing the WellStreet mission to provide uncompromising service. • A compelling desire to serve others, improve your community's health, and have fun every day.
INDmisc
Practice Coding Specialist - Practice
Medical coder job in Atlanta, GA
Northside Hospital is award-winning, state-of-the-art, and continually growing. Constantly expanding the quality and reach of our care to our patients and communities creates even more opportunity for the best healthcare professionals in Atlanta and beyond. Discover all the possibilities of a career at Northside today.
Responsibilities
Responsible for coding procedures and entering charges to comply with federal/state regulations and internal policies. Coordinate with Practice Coordinator and Revenue Integrity to assure all necessary documentation is present to support selected procedure codes or to code cases as needed. Participates in audits to evaluate if all selected codes are accurate and develops methodologies to improved coding issues identified.
Qualifications
REQUIRED:
1. Must have a coding credential (RHIA, RHIT, CPC, CCS, RN).
2. Must have minimum of 2 years hospital and/or physician practice coding experience or successful completion of the one-year Revenue Integrity Internship Program.
3. Demonstrated communication skills and an ability to work independently and deal effectively with various types of personnel.
4. Knowledge of Microsoft Office products.
PREFERRED:
1. B.S. degree in Nursing, Health Information Management, Healthcare Administration, Business Administration preferred.
2. Three to five years of experience in a hospital and/or physician practice setting.
Work Hours: 7:30-4 Weekend Requirements: No On-Call Requirements: No
Auto-ApplyMedical Coder - Wound Care
Medical coder job in Gainesville, GA
Medical Coder - Wound Care (Long -Term Care)
About Us Pinnacle Wound Management is a physician -led wound care provider dedicated to improving healing outcomes for patients in skilled nursing and long -term care facilities. We partner with facilities to deliver advanced wound care at the bedside, supported by thorough documentation, EMR integration, and compliance with payer guidelines.
We are seeking a Medical Coder with wound care experience to join our team. This role is critical in ensuring timely, accurate coding and billing for patient encounters and cellular tissue product usage across multiple facilities.
Key Responsibilities
Accurately review and code wound care services performed in long -term care and post -acute settings, ensuring compliance with ICD -10, CPT, HCPCS, and payer requirements
Code independently without reliance on a provider superbill, using clinical notes and documentation as the source of truth
Release daily coding batches to support timely revenue cycle processing
Code red -label (cellular tissue) products and ensure proper documentation of lot numbers and graft application details
Assist and work closely with the billing team to correct coding errors and resolve claim rejections/denials
Generate detailed coding reports and batch logs for submission to the Director of Operations
Collaborate with the billing and operations teams to reconcile coding discrepancies and ensure compliance
Monitor payer and CMS updates impacting wound care coding, documentation, and compliance
Maintain coding accuracy, productivity standards, and adherence to compliance regulations
Qualifications
Certification strongly preferred: CPC (Certified Professional Coder), CCS, or equivalent
Minimum 2 years of experience in medical coding; wound care or long -term care experience highly preferred
Strong knowledge of ICD -10, CPT, and HCPCS coding guidelines
Ability to code directly from clinical notes/documentation without superbill support
Experience coding cellular tissue/red -label products a plus
Proficient in generating coding reports, logs, and error correction documentation
Detail -oriented with excellent organizational skills and ability to manage coding batches daily
Comfortable working independently with minimal supervision
What We Offer
Competitive compensation package
Opportunity to specialize in wound care and advanced procedures in the long -term care space
Supportive team environment focused on compliance and patient -centered outcomes
Medical Coding Appeals Analyst
Medical coder job in Atlanta, GA
Sign On Bonus: $1,000 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law
This position is not eligible for employment based sponsorship.
Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.
PRIMARY DUTIES:
* Review medical record documentation in support of Evaluation and Management, CPT, HCPCS and ICD-10 code.
* Reviews company specific, CMS specific, and competitor specific medical policies, reimbursement policies, and editing rules, as well as conducting clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy.
* Translates medical policies into reimbursement rules.
* Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits.
* Coordinates research and responds to system inquiries and appeals.
* Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy.
* Perform pre-adjudication claims reviews to ensure proper coding was used.
* Prepares correspondence to providers regarding coding and fee schedule updates.
* Trains customer service staff on system issues.
* Works with providers contracting staff when new/modified reimbursement contracts are needed.
Minimum Requirements:
Requires a BA/BS degree and a minimum of 2 years related experience; or any combination of education and experience, which would provide an equivalent background. Certified Professional Coder (CPC) or Registered Health Information Administrator (RHIA) certification required.
Preferred Skills, Capabilities and Experience:
* CEMC, RHIT, CCS, CCS-P certifications preferred.
Job Level:
Non-Management Exempt
Workshift:
Job Family:
MED > Licensed/Certified - Other
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
HCC Risk Adjustment Coder - Full Time
Medical coder job in Atlanta, GA
Datavant is a data platform company and the world's leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format.
Our platform is powered by the largest, most diverse health data network in the U.S., enabling data to be secure, accessible and usable to inform better health decisions. Datavant is trusted by the world's leading life sciences companies, government agencies, and those who deliver and pay for care.
By joining Datavant today, you're stepping onto a high-performing, values-driven team. Together, we're rising to the challenge of tackling some of healthcare's most complex problems with technology-forward solutions. Datavanters bring a diversity of professional, educational and life experiences to realize our bold vision for healthcare.
As an HCC (Hierarchical Condition Category) coder you will review medical records to identify and code diagnoses using a standardized system, ensuring accurate representation of patient conditions for risk adjustment and reimbursement purposes. You will play a critical role in translating clinical documentation into precise codes that reflect the complexity and severity of a patient's health status.
You will:
Review, analyze, and code diagnostic information in a patient's medical record based on client specific guidelines for the project.
The coder will ensure compliance with established ICD-10 CM, third party reimbursement policies, regulations and accreditation guidelines.
Coders must meet and maintain a 95% coding accuracy rate.
Any other task requested by leadership.
What you will bring to the table:
AHIMA certified credentials (RHIA, RHIT, CCS) or AAPC certified credentials (CPC, CPC-H, COC, CIC, or CRC).
A minimum of 2 years HCC coding experience, while certified.
Full understanding and knowledge of ICD-10, medical terminology, medical abbreviations, pharmacology and disease processes.
Ability to be flexible in the work environment.
Ability to work in a fast paced production environment while maintaining high quality.
Must be able to follow instructions, meet deadlines and work independently.
Excellent written and verbal communication skills, problem solve, ability to work in a remote environment, and time management skills.
Working knowledge of the business use of computer hardware and software to ensure effectiveness and quality of the processing and security of the data.
Must be able to use Microsoft Office with no training.
Ability to be able work on multiple client projects simultaneously, if needed.
This position has a base pay of $19.60/hour plus the option to earn up to $3.25 per chart based on quality and production.
To ensure the safety of patients and staff, many of our clients require post-offer health screenings and proof and/or completion of various vaccinations such as the flu shot, Tdap, COVID-19, etc. Any requests to be exempted from these requirements will be reviewed by Datavant Human Resources and determined on a case-by-case basis. Depending on the state in which you will be working, exemptions may be available on the basis of disability, medical contraindications to the vaccine or any of its components, pregnancy or pregnancy-related medical conditions, and/or religion.
This job is not eligible for employment sponsorship.
Datavant is committed to a work environment free from job discrimination. We are proud to be an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, or other legally protected status. To learn more about our commitment, please review our EEO Commitment Statement here. Know Your Rights, explore the resources available through the EEOC for more information regarding your legal rights and protections. In addition, Datavant does not and will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay.
At the end of this application, you will find a set of voluntary demographic questions. If you choose to respond, your answers will be anonymous and will help us identify areas for improvement in our recruitment process. (We can only see aggregate responses, not individual ones. In fact, we aren't even able to see whether you've responded.) Responding is entirely optional and will not affect your application or hiring process in any way.
Datavant is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need an accommodation while seeking employment, please request it here, by selecting the ‘Interview Accommodation Request' category. You will need your requisition ID when submitting your request, you can find instructions for locating it here. Requests for reasonable accommodations will be reviewed on a case-by-case basis.
For more information about how we collect and use your data, please review our .
Auto-ApplyMedical Coding Appeals Analyst
Medical coder job in Atlanta, GA
Sign On Bonus: $1,000 Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law
This position is not eligible for employment based sponsorship.
Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.
PRIMARY DUTIES:
* Review medical record documentation in support of Evaluation and Management, CPT, HCPCS and ICD-10 code.
* Reviews company specific, CMS specific, and competitor specific medical policies, reimbursement policies, and editing rules, as well as conducting clinical research, data analysis, and identification of legislative mandates to support draft development and/or revision of enterprise reimbursement policy.
* Translates medical policies into reimbursement rules.
* Performs CPT/HCPCS code and fee schedule updates, analyzing each new code for coverage, policy, reimbursement development, and implications for system edits.
* Coordinates research and responds to system inquiries and appeals.
* Conducts research of claims systems and system edits to identify adjudication issues and to audit claims adjudication for accuracy.
* Perform pre-adjudication claims reviews to ensure proper coding was used.
* Prepares correspondence to providers regarding coding and fee schedule updates.
* Trains customer service staff on system issues.
* Works with providers contracting staff when new/modified reimbursement contracts are needed.
Minimum Requirements:
Requires a BA/BS degree and a minimum of 2 years related experience; or any combination of education and experience, which would provide an equivalent background. Certified Professional Coder (CPC) or Registered Health Information Administrator (RHIA) certification required.
Preferred Skills, Capabilities and Experience:
* CEMC, RHIT, CCS, CCS-P certifications preferred.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Auto-ApplyBilling & Coding Specialist
Medical coder job in Atlanta, GA
We are seeking a qualified and dedicated Billing and Coding Specialist to join our Central Billing Office. In this position, you will be responsible for a variety of tasks requiring data analysis, in-depth evaluation, and sound judgment. As our Biller and Coder, your daily duties will include entering and coding patient services and charges into our EMR system and generating invoices to mail out to patients. The ideal candidate must also be able to demonstrate excellent written and verbal communication skills, as communicating with clients and various insurance agents or patients will form a large part of the job.
DUTIES:
* Remain HIPAA and OSHA compliant.
* Translate patient information and alphanumeric medical code entries.
* Electronic "clean" claims submissions to Insurance Carriers.
* Collect, post, and manage patient account payments.
* Sort and file paperwork.
* Analyzing and correcting coding errors.
* Ensure healthcare facilities are reimbursed for all procedures.
* Follow Up on accepted or denied claims.
* Review denied claims for denial reasons and provide resolution.
* Investigate insurance fraud and report if found.
* Collect information regarding patient treatments, diagnosis, and related procedures to ensure proper coding.
Qualifications:
* A minimum of 2 years' experience as a Medical Biller or similar role.
* Knowledge of unfair debt collection practices and insurance guidelines.
* Understanding of primary code classifications: ICD-10 CM, ICD-10-PCS, CPT and HCPCS
* Computer proficiency and medical billing software
* Must have the ability to multitask and manage time effectively.
* Excellent written and verbal communication skills.
* Outstanding problem-solving and organizational abilities.
* Productivity Driven.
EDUCATION AND EXPERIENCE:
* High School, Associate Degree or 1-3 years of Billing and Coding experience
* Professional Certification preferred
Ortho Sport and Spine Physicians is an Equal Opportunity Employer and does not discriminate in its employment practices on the basis of race, religion, sex, color, national origin, age, disability, citizenship, genetic information, veteran status, military service, or any other characteristic protected by federal law or Georgia law.
Certified Peer Specialist
Medical coder job in Marietta, GA
This position of moderate difficulty is responsible for providing a variety of case management and outreach interventions to consumers in their natural environment. Individual serves as advocate in assisting consumers in accessing community resources, teaching and modeling self-help and coping skills. Must be able to develop WRAP Plans.
Minimum Training & Experience:
A Certified Peer Specialist certificate, or certificate eligible within six months.
Preferred Qualifications:
Preference will be given to applicants who, in addition to meeting the minimum qualifications, possess one or more years in recovery.
Problem Solving / Decision Making Skills:
Must have excellent assessment and crisis management skills. Candidate will work closely with metro area hospitals, city/county jails and courts. Must be able to negotiate system boundaries.
TRAIME BEHAVIORAL HEALTH INC is an EEO Employer - M/F/Disability/Protected Veteran Status View all jobs at this company
Medical Records Specialist
Medical coder job in Atlanta, GA
Confident Staff Solutions is a leading staffing agency in the healthcare industry, specializing in providing top talent to healthcare organizations across the country. Our team is dedicated to helping healthcare facilities improve patient outcomes and achieve their goals by connecting them with highly skilled and qualified professionals.
Overview:
We are offering a HEDIS course to individuals looking to start working as a HEDIS Abstractor. Once the course is completed, we will connect you with hiring recruiters looking to hire for the upcoming HEDIS season.
HEDIS Course: Includes
- Medical Terminology
- Introduction to HEDIS
- HEDIS Measures (CBP, LSC, CDC, BPM, CIS, IMA, CCS, PPC, etc)
- Interview Tips
Self-Paced Course
https://courses.medicalabstractortemps.com/courses/navigating-hedis-2026
Medical Billing & Coding Specialist
Medical coder job in Duluth, GA
Job Description
Culture and Values:
At Pandya Medical Center, we believe in going above and beyond for every patient. Our team members are dedicated professionals who truly care about making a difference. We listen, understand, and treasure each personal story shared by our patients. Our commitment extends beyond our clinic walls, with active involvement in community health fairs and volunteering initiatives. We are a highly reputed medical practice in North Atlanta, offering strong growth opportunities and robust benefits for our employees. Be a part of our dynamic team and take your career to the next level with Pandya Medical Center.
Job Summary
The Medical Billing & Coding Specialist assures accurate and complete coding information is collected and reported to private insurance and Medicare to help complete the revenue cycle. The specialist will scrub encounters for accurate coding prior to claim creation, assure correct modifiers and ICD10 diagnosis codes are allocated to each CPT code, ensure timely claim submissions and follow-up on claim denials. The candidate should have knowledge of insurance regulations and medical coding with the goal of maximizing accurate third-party billing and minimizing denials. The position is full time with competitive salary, and strong benefits including PTO, health insurance and 401k match. The ideal candidate will be able to be present at our administrative office in the Johns Creek area. If you are an experienced and motivated Medical Billing & Coding Specialist who wants to grow with a thriving medical practice, we encourage you to apply today and join our dedicated team at Pandya Medical Center.
Duties and Responsibilities
Accurate and timely submission of medical claims to insurance companies and other payers
Review and analyze medical records to ensure appropriate coding of diagnoses and procedures
Document for providers and management any insufficient or unclear information on claims
Assign or reassign CPT, HCPCS, and ICD-10-CM codes as needed
Follow up on unpaid claims and initiate appeals for denied claims within 30 days of submission.
Track the progress of claims through the clearinghouse and promptly address any issues
Resolve patient billing issues and questions via phone and email in a timely fashion
Stay updated on healthcare regulations, medical terminology, and coding practices
Follow HIPAA guidelines when accessing and sharing patient information
Additional job related duties or projects as needed
Qualifications and Skills
Minimum of 3 years' experience with medical billing or revenue cycle in a medical setting
Certified Professional Coder thru AAPC or a Certified Coding Specialist thru AHIMA - Required
Knowledge of insurance guidelines including HMO/PPO, Medicare and other payers' requirements and systems
Knowledge of CPT, ICD-10, HCPCS Coding and utilization of modifiers
Knowledge of medical billing rules, modifiers, and strong understanding of EOBs and ERAs
Competent in computer skills, Microsoft Office or similar software
Experience with AthenaHealth EHR is preferred or other similar EHR systems such as Epic, or eClinicalWorks
Experience with Family Practice and Primary Care outpatient billing (Preferred)
Exceptional Customer Service skills for interacting with patients regarding medical claims and payments
Self-motivated with ability to multi-task, prioritize work in a fast-paced, team environment
Problem-solving skills to research and resolve discrepancies, denials, appeals, collections
Strong understanding of patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Benefit Eligibility
Health insurance
Dental and Vision plans
Supplemental insurance plans
401K match plan with up to 4% by Pandya Medical Center
Paid Time Off
PGA Certified STUDIO Performance Specialist
Medical coder job in Roswell, GA
Overview (pay range: 15-23 HR)
At PGA TOUR Superstore, we are always looking for enthusiastic, self-motivated, flexible individuals who will share a passion for helping transform our business. As one of the fastest growing specialty retailers, we are dedicated to hiring selfless team players from different backgrounds to influence the growth of our organization. Part of the Arthur M. Blank Family of Businesses, PGA TOUR Superstore continuously strives to create a family culture for our Associates - driven by our vision to inspire people through golf and tennis.
Position Summary
Reporting to the Sales and Service Manager, the STUDIO Performance Specialist delivers world-class service through expert instruction and precision fitting. This hybrid role blends the responsibilities of a Golf Instructor and a Fitting Specialist, ensuring every customer receives a tailored experience that improves their game and drives lasting relationships.
The STUDIO Performance Specialist is responsible for achieving KPIs across both fittings and lessons, proactively growing their client base, and maintaining a fully booked schedule. The role also supports the visual and operational excellence of the STUDIO, leveraging advanced technology and product knowledge to deliver measurable performance results.
Key Responsibilities:
Customer Experience & Engagement
Engage every customer with world-class service by demonstrating PGA TOUR Superstore's Service Behaviors.
Build lasting relationships that encourage repeat business and client referrals.
Educate and inspire customers by connecting instruction and equipment performance to game improvement.
Instruction & Coaching
Conduct one-on-one lessons, clinics, and group events tailored to player needs, goals, and skill levels.
Utilize technology such as TrackMan, SAM PuttLab, and USchedule to deliver data-driven instruction.
Develop personalized lesson plans and track student progress, providing constructive feedback and measurable improvement.
Proactively organize clinics and performance events to build customer engagement and community participation.
Fitting & Equipment Performance
Execute professional club fittings using PGA TOUR Superstore's certified fitting techniques and technology.
Maintain a brand-agnostic approach to ensure customers are fit for the best equipment based on their unique swing data and goals.
Educate customers on product features, benefits, and performance differences across brands.
Accurately enter and manage custom orders, ensuring all specifications are documented precisely.
Operational & Visual Excellence
Maintain all STUDIO areas (simulators, components drawers, putting green) to the highest visual and operational standards.
Ensure equipment, software, and technology remain functional and calibrated.
Support front-end operations, including returns, lesson redemptions, loyalty programs, and promotions.
Stay current on marketing campaigns and merchandising events, executing promotional setups and maintaining accurate displays.
Performance & Business Growth
Achieve key performance indicators (KPIs) such as:
Lessons and fittings completed
Sales per hour and booking percentage
Clinic participation and conversion to sales
Proactively grow the STUDIO business through client outreach, networking, and relationship management.
Provide consistent feedback to the Sales and Service Manager to improve operations, merchandising, and customer experience.
Qualifications and Skills Required
Certification:
Only PGA Members and Apprentices in good standing with the PGA of America are eligible for this role. The candidate must maintain good standing with the PGA for the duration of employment. The candidate may be asked to provide proof of PGA membership in the form of a current membership card or proof of membership dues payment.
Communication: Strong interpersonal, listening, and verbal/written communication skills with the ability to engage and educate customers.
Technical Proficiency: Working knowledge of Microsoft Office Suite and fitting/instruction technology (TrackMan, SAM PuttLab, USchedule).
Organization: Ability to manage multiple priorities, maintain schedules, and meet deadlines.
Education: High school diploma or equivalent required; PGA certification or equivalent instruction credentials preferred.
Experience:
2+ years of golf instruction and club fitting experience preferred.
Experience with swing analysis tools and custom club building highly valued.
Physical Demands: Must be able to stand for extended periods, move throughout the store, lift up to 30 lbs overhead, and work in simulator environments.
Availability: Must maintain flexible availability, including nights, weekends, and holidays.
Accountability: Demonstrates strong self-accountability, professionalism, and a proactive drive for results.
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
PGA TOUR Superstores is an Equal Opportunity Employer, committed to a diverse and inclusive work environment.
We comply with all laws that prohibit discrimination based on race, color, religion, sex/gender, age (40 and over), national origin, ancestry, citizenship status, physical or mental disability, veteran status, marital status, genetic information, and any other legally protected status. Employment discrimination isn't just unlawful, it violates our policies and is not who we are. Every associate at every level in the organization is prohibited from engaging in any form of discrimination.
An associate who believes s/he is being discriminated against should report it immediately to the Human Resources department. The law and our policies prohibit retaliation against anyone for making such a report.
Auto-Apply1. Billing & Coding Specialist
Medical coder job in Dallas, GA
Job DescriptionBilling & Coding Specialist
Job Type: Full-Time
About Us
At COCAS & ME Living, we provide housing, therapy, case management, and recovery programs for individuals and families overcoming domestic violence, substance abuse, incarceration, and homelessness.
As we expand our Medicaid, Medicare, and insurance-billable services, we are seeking a Billing & Coding Specialist to ensure accurate, compliant, and timely billing that sustains our mission.
Position Summary
The Billing & Coding Specialist is responsible for managing the full cycle of medical and program billing, including coding accuracy, claims submission, payment posting, and denial management. This role ensures the organization maximizes reimbursement while staying compliant with regulations.
Key Responsibilities
Accurately assign ICD-10, CPT, and HCPCS codes for therapy, medical, housing-related, and case management services.
Submit claims to Medicaid, Medicare, and private insurance providers.
Track claims, post payments, and resolve denials or rejections.
Maintain compliance with HIPAA, CMS, and payer-specific requirements.
Work with case managers and therapists to ensure proper documentation for billing.
Generate billing reports for leadership and finance teams.
Assist with audits and maintain accurate billing records.
Skills & Competencies
Proficiency in medical coding (ICD-10, CPT, HCPCS).
Knowledge of Medicaid/Medicare rules and billing processes.
Experience with EHR/EMR systems and billing software.
Strong organizational and recordkeeping skills.
Analytical problem-solving for denial management.
Attention to detail and ability to meet deadlines.
Qualifications
Certified Professional Coder (CPC, CCA, or equivalent) preferred.
13 years experience in medical billing & coding.
Experience with nonprofit or behavioral health billing a plus.
Familiarity with Medicaid waiver programs and housing support services is beneficial.
Compensation & Benefits
Pay: $18 $27 per hour (based on certification & experience).
Flexible schedule (remote/hybrid options available).
Opportunities for growth into Billing Supervisor or Revenue Cycle Manager roles.
Join a mission-driven organization making a lasting impact.
How to Apply
Send your resume + certifications to: ************
Questions? Call us: ************
Learn more: *************
***********************************************************************************
Use subject line:
Billing & Coding Specialist Application [Your Name]
Easy ApplyMedical Records Health Information Management
Medical coder job in Gainesville, GA
As Medical Records Director, you are the administrative authority, responsibility, and accountability necessary for carrying out your assigned duties. The primary purpose of your job position is to assure that the medical records are maintained in accordance with Federal and State Guidelines, as well as in accordance with our established policies and procedures, to assure that a complete medical records is maintained. Medical Records Director must process and maintain private patient information in the health care facility's database. Medical Records Director assess patient records to ensure they are complete and accurate.
Enter data, such as demographic characteristics, history and, diagnostic procedures, or treatment into computer.
Enter patient or treatment data into computers.
Maintain, medical facility records or storage and retrieval systems to collect, classify, store, or information.
Prepare medical records for Insurance and Legal Requests as required.
Contact Physicians regarding incomplete charts.
Assist Nursing staff and physicians with Death Certificates.
Respond to requests for records from Federal, State or County Courts, Hospitals, Physicians and Insurance after getting direction from Administrator.
Scan all Medical Records as Policy States, within 24 hours you receive documents.
Perform chart Audits as follows:
Admission Audits
Weekly audits of physician visits, progress notes
Monthly audits of progress notes for all departments, monthly summaries, history and physical, etc., to ensure all forms are present and completed.
Discharge audit-Charts must be complete within 72 hours including discharge summary.
Do weekly Audits to ensure that all Residents have a Complete Medical Record.
Attend in-service education programs in order to meet facility educational requirements.
Be familiar with Standard Precautions, Exposure, Control Plan, Fire Drill and Evaluation Procedures and know how to use them.
We provide compassionate and personal 24-hour skilled care and rehabilitation services in a comfortable and friendly environment. Caring is our main concern. We believe the most effective way to provide compassionate care is to maintain high medical integrity, build a team spirit among staff, and provide friendly, beautiful surrounding for our patients.
Enter data, such as demographic characteristics, history and, diagnostic procedures, or treatment into computer.
Enter patient or treatment data into computers.
Maintain, medical facility records or storage and retrieval systems to collect, classify, store, or information.
Prepare medical records for Insurance and Legal Requests as required.
Contact Physicians regarding incomplete charts.
Assist Nursing staff and physicians with Death Certificates.
Respond to requests for records from Federal, State or County Courts, Hospitals, Physicians and Insurance after getting direction from Administrator.
Scan all Medical Records as Policy States, within 24 hours you receive documents.
Perform chart Audits as follows:
Admission Audits
Weekly audits of physician visits, progress notes
Monthly audits of progress notes for all departments, monthly summaries, history and physical, etc., to ensure all forms are present and completed.
Discharge audit-Charts must be complete within 72 hours including discharge summary.
Do weekly Audits to ensure that all Residents have a Complete Medical Record.
Attend in-service education programs in order to meet facility educational requirements.
Be familiar with Standard Precautions, Exposure, Control Plan, Fire Drill and Evaluation Procedures and know how to use them.
Qualifications:
High School Graduate
3+ years' experience in handling medical records in a licensed medical facility
Exceptional organizational skills
Data Entry (40-50 wpm)
Proficient in information management programs and MS Office
Excellent interpersonal and organizational skills
Strong attention to detail
Outstanding communication and interpersonal abilities
Proficient in computer programs, including Microsoft Office and Outlook
Knowledge of medical terminology
Must be computer literate
Comply with the Residents Rights and Facility Policies and Procedures
Medical Records/Billing Specialist
Medical coder job in Griffin, GA
Job Description
About the Role:
The Medical Records/Billing Specialist plays a crucial role in the healthcare system by ensuring that patient records are accurately maintained and billing processes are efficiently executed. This position is responsible for managing patient information, including medical histories, treatment plans, and billing details, to facilitate seamless healthcare delivery. The specialist will work closely with healthcare providers to ensure that all documentation meets regulatory standards and is readily accessible for patient care. Additionally, they will handle billing inquiries, process insurance claims, and ensure timely payments, contributing to the financial health of the organization. Ultimately, the Medical Records/Billing Specialist ensures that both patient care and administrative functions operate smoothly and effectively.
Minimum Qualifications:
High school diploma or equivalent.
Experience in medical billing and coding or a related field.
Knowledge of healthcare regulations and medical terminology.
Preferred Qualifications:
Associate's degree in health information management or a related field.
Certification as a Medical Billing Specialist (CMBS) or similar credential.
Experience with electronic health record (EHR) systems.
Responsibilities:
Maintain and update patient medical records in compliance with healthcare regulations.
Process billing and insurance claims accurately and in a timely manner.
Assist Office Nurse with scheduling patient visits.
Ensure confidentiality and security of patient information in accordance with HIPAA regulations.
Skills:
The required skills for this role include attention to detail, which is essential for accurately maintaining patient records and processing billing information. Strong communication skills are necessary to effectively interact with patients, healthcare providers, and insurance representatives. Proficiency in medical coding and billing software is crucial for efficient claim processing and ensuring compliance with regulations. Additionally, organizational skills are important for managing multiple tasks and maintaining accurate records. Preferred skills, such as familiarity with EHR systems, enhance the ability to streamline workflows and improve overall efficiency in the medical billing process.
Coding Specialist - TMG Billing (Days)
Medical coder job in Carrollton, GA
The Coding Specialist is responsible for accurately assigning ICD-10-CM, CPT, and HCPCS codes for professional services across a multi-specialty medical group. This position ensures compliant, complete, and timely coding of all encounters to support proper claim submission, revenue integrity, and clinical documentation accuracy. The specialist will collaborate closely with providers, billing, and revenue cycle teams to resolve coding-related denials and identify process improvement opportunities.
Key Responsibilities
Assign appropriate ICD-10-CM, CPT, and HCPCS codes in accordance with official coding guidelines, payer policies, and organizational standards.
Review provider documentation for accuracy and completeness, querying providers when clarification is needed to ensure correct code assignment and compliance with regulatory standards.
Monitor and analyze claim rejections, denials, and trends to identify root causes and recommend corrective actions.
Provide feedback and education to providers and staff regarding documentation improvement and coding updates.
Participate in internal audits and quality assurance reviews to maintain a high level of coding accuracy.
Collaborate with billing and A/R teams to resolve coding-related issues impacting reimbursement.
Initiate follow-up communication with clients, payers, and internal departments to ensure timely resolution of coding and billing discrepancies.
Education
High School Diploma or equivalent required.
Completion of an accredited medical coding or health information management program preferred.
Experience
Minimum of one (1) year of professional coding experience in a multi-specialty or physician practice setting required.
Experience with EPIC EHR.
Licenses & Certifications
Required: Certified Professional Coder (CPC, CIC, COC, CCS, or CCS-P) or equivalent certification.
Specialty certification (e.g., AAPC specialty credentials) preferred.
Knowledge, Skills & Abilities
Thorough knowledge of ICD-10-CM, CPT, and HCPCS coding systems and official guidelines.
Familiarity with insurance payer rules, billing processes, and denial management.
Strong analytical and problem-solving skills with the ability to interpret data and form actionable recommendations.
Proficient in Microsoft Office applications (Word, Excel, Outlook).
Excellent attention to detail, organizational, and time management skills.
Effective communication and interpersonal abilities; capable of working independently and collaboratively within a team environment.
Professional demeanor and commitment to maintaining confidentiality and compliance with HIPAA regulations.
Practice Coding Specialist - NHDC
Medical coder job in Gainesville, GA
Northside Hospital is award-winning, state-of-the-art, and continually growing. Constantly expanding the quality and reach of our care to our patients and communities creates even more opportunity for the best healthcare professionals in Atlanta and beyond. Discover all the possibilities of a career at Northside today.
Responsibilities
Responsible for coding procedures and entering charges to comply with federal/state regulations and internal policies. Coordinate with Practice Coordinator and Revenue Integrity to assure all necessary documentation is present to support selected procedure codes or to code cases as needed. Participates in audits to evaluate if all selected codes are accurate and develops methodologies to improved coding issues identified.
Qualifications
REQUIRED:
1. Must have a coding credential (RHIA, RHIT, CPC, CCS, RN).
2. Must have minimum of 2 years hospital and/or physician practice coding experience or successful completion of the one-year Revenue Integrity Internship Program.
3. Demonstrated communication skills and an ability to work independently and deal effectively with various types of personnel.
4. Knowledge of Microsoft Office products.
PREFERRED:
1. B.S. degree in Nursing, Health Information Management, Healthcare Administration, Business Administration preferred.
2. Three to five years of experience in a hospital and/or physician practice setting.
Work Hours: 8-4:30PM Weekend Requirements: No On-Call Requirements: No
Auto-ApplyCoding Specialist - TMG Billing (Days)
Medical coder job in Carrollton, GA
The Coding Specialist is responsible for accurately assigning ICD-10-CM, CPT, and HCPCS codes for professional services across a multi-specialty medical group. This position ensures compliant, complete, and timely coding of all encounters to support proper claim submission, revenue integrity, and clinical documentation accuracy. The specialist will collaborate closely with providers, billing, and revenue cycle teams to resolve coding-related denials and identify process improvement opportunities.
Key Responsibilities
* Assign appropriate ICD-10-CM, CPT, and HCPCS codes in accordance with official coding guidelines, payer policies, and organizational standards.
* Review provider documentation for accuracy and completeness, querying providers when clarification is needed to ensure correct code assignment and compliance with regulatory standards.
* Monitor and analyze claim rejections, denials, and trends to identify root causes and recommend corrective actions.
* Provide feedback and education to providers and staff regarding documentation improvement and coding updates.
* Participate in internal audits and quality assurance reviews to maintain a high level of coding accuracy.
* Collaborate with billing and A/R teams to resolve coding-related issues impacting reimbursement.
* Initiate follow-up communication with clients, payers, and internal departments to ensure timely resolution of coding and billing discrepancies.
Education
* High School Diploma or equivalent required.
* Completion of an accredited medical coding or health information management program preferred.
Experience
* Minimum of one (1) year of professional coding experience in a multi-specialty or physician practice setting required.
* Experience with EPIC EHR.
Licenses & Certifications
* Required: Certified Professional Coder (CPC, CIC, COC, CCS, or CCS-P) or equivalent certification.
* Specialty certification (e.g., AAPC specialty credentials) preferred.
Knowledge, Skills & Abilities
* Thorough knowledge of ICD-10-CM, CPT, and HCPCS coding systems and official guidelines.
* Familiarity with insurance payer rules, billing processes, and denial management.
* Strong analytical and problem-solving skills with the ability to interpret data and form actionable recommendations.
* Proficient in Microsoft Office applications (Word, Excel, Outlook).
* Excellent attention to detail, organizational, and time management skills.
* Effective communication and interpersonal abilities; capable of working independently and collaboratively within a team environment.
* Professional demeanor and commitment to maintaining confidentiality and compliance with HIPAA regulations.
Area of Responsibilities
* Generates monthly reports and staff education. Completes statistical gathering and reporting as needed.
* Performs quality assurance reviews of all entries completed by the patient registrars and reports to administration.
* Performs the coding function to assure timely and accurate billing of insurance claims.
* Prepares monthly performance reports that indicate the impact of work done. This will be done thru the analysis of Aging Reports, Accounts Receivable Reports, and other related documentation.
* Works closely with registrars and medical providers in the department to solve problems and make process improvements.
* Analyzes work on hand on a daily basis and determines how to allocate manpower in an effort to prioritize time.
* Assists with special projects and account analysis procedures when needed.
* Assures accuracy of all CPT and ICD-10 coding.
* Completes data entry for charges.
* Conducts chart review to review clinical documentation and evaluate the appropriateness of coding.
* Coordinate the development and the implementation of billing and collection policies and procedures.
* Corrects all data errors and re-files all claims returned or unprocessed.
* Develops and maintains a high level of expertise in Billing and Collection rules and regulations by reading and studying all applicable bulletins, newsletters, etc.
* Explains insurance benefits, filing procedures, and policy requirements to patients and registrars as needed.
* Handles returned checks/certified mail weekly.
* Indicates follow-up telephone calls and enters detailed comments in the billing system.
* Informs providers and staff of changes in insurance requirements that my affect the billing and claims filing processes.
* Maintains certification in physician practice coding.
* Maintains a good relationship with physician practice for the purpose of resolving billing problems.
* Maintains a working knowledge of department and facility policies and procedures. Displays independent reasoning skills for problem resolution as required with the scope of job assignments.
* Maintains strict confidentiality.
* Prepares documentation for physician review.
* Process month end billing.
* Provides comprehensive analysis and follow-up to all account balances.
* Provides high quality customer service functions to include addressing patient inquiries and complaints from all sources in a timely manner. Initiates necessary corrections to patients accounts and attempts to repair any damage done to relationship with patient. This will require interaction with co-workers, physician offices, and insurance carriers. Success indicated when problems are resolved by team members requiring little director intervention.
* Researches and prepares appeals for any denied or unpaid claims.
* Responsible for analyzing credit balance accounts and initiating refund request.
* Reviews adjustments for accuracy.
* Reviews all insurance EOB forms to assure proper adjudication and payment of each claim.
Compliance Statement
Employee performs within the prescribed limits of Tanner Health System's Ethics and Compliance program. Is responsible to detect, observe, and report compliance variances to their immediate supervisor, the Compliance Officer, or the Hotline.
Education
High School Diploma plus 1 year vocational school
Experience
One year of related experience. Requires a working knowledge of standard practices and procedures.
Licenses & Certifications
* CERTIFIED CODING SPECIALIST
Supervision
* Provides on-going education of clinical staff regarding proper documentation and coding. Regularly leads the work of coworkers and checks performance of work for accuracy.
Qualifications
* Ability to analyze data and form recommendations
* Ability to organize, analyze, and prioritize work load.
* Ability to work closely with others and function as a team number.
* Data entry experience preferred. Must utilize multiple practice software systems.
* Detail oriented.
* Exhibits exceptional communication skills.
* Must have coding certification to include CPC, CPC-H, CCS, CCS-P. Specialty certification through American Academy of Professional Coders is acceptable.
* One year previous medical office billing and collection experience required.
* Professional appearance.
* Proficient in various office software such as Office and Excel.
* Working knowledge of ICD-9 and CPT coding required. Coding certification required. Requires experience in physician practice coding.
Definitions
* Responsible for the oversight of the assignment of ICD-9 and CPT coding for claims. Duties will include monitoring the accuracy of insurance claims, identifying opportunities for improvement, and providing staff education. Initiating follow-up telephone calls to clients, business office, and payers. Responsible for maintaining an accurate charge master with accurate CPT coding. Responsible for analyzing A R issues and providing staff education to improve the collection rate for the clinic.
Contact With Others
Requires frequent contact with many persons at different levels inside and outside of the organization to carry out organization policies and programs and obtain willing acceptance, consent, or action.
Effect Of Error
Probable errors not easily detected and may adversely affect external as well as internal relationships and may result in major expenditures for equipment, materials, or procedures detrimental to the patient's welfare or the organization's interest. Work is subject to general review only and requires considerable accuracy and responsibility. Continually works with reports, records, plans, and programs of a major functional area of the organization where integrity is required to safeguard the organization's position. Duties may involve the preparation of data on which the administration bases important decisions and are highly confidential.
Supervisory Responsibility
Regularly uses assistance of aide or helper or leads the work of one to four co-employees; checks performance of work assigned as to accuracy and time, doing same work, it's more difficult aspects, or other related work
Mental Demands
Work involves a variety of problems in a general field, some of which are complex. Involves some independent judgment to decide what to do to assemble facts, determine variations from standard procedures, or plan other action to be taken to meet general objectives.
Physical Effort
Minor physical effort - Job requires person to stand and/or walk frequently. Lifts, carries, or uses lightweight (1 to 25 lbs.) materials or equipment less than half of the day. Works in reaching or strained position intermittently. Office or laboratory work requires close visual effort less than half of day. Office or Laboratory work with concentration on a monotonous, repetitious procedure or skill most of day, where speed and accuracy are essential.
Working Conditions
Generally pleasant working conditions/normal office environment.
Working Conditions Aspects For Immunizations
* Directly works with Patients less than 12 months of age
Physical Aspects
Continually (at least once per day)
* Visual
Frequently (at least 3 times a week)
* Typing
* Manual Dexterity -- picking, pinching With fingers etc.
* Hearing
* Speaking
Occasionally (at least once a month)
* Bending
* Reaching -- above shoulder
* Reaching -- below shoulder
* Standing
* Walking
* Lifting up To 25 lbs.
* Handling -- seizing, holding, grasping
* Carrying
* Pushing/Pulling -- up To 25 lbs.