Coder II

Description

A. POSITION SUMMARY The Accounts Receivable (AR) Coding Specialist is responsible for ensuring accurate coding of outpatient services to support timely and appropriate reimbursement. This role involves managing accounts receivable by resolving denied claims, addressing coding-related issues, and collaborating with providers to ensure proper documentation. B. ESSENTIAL DUTIES AND RESPONSIBILITIES Assign appropriate ICD-10, CPT, and HCPCS codes to outpatient diagnoses and procedures by reviewing provider documentation. Investigate and resolve coding-related claim denials by correcting and resubmitting claims to payers. Communicate with physicians and clinical staff to clarify documentation discrepancies and improve coding accuracy. Ensure coding practices adhere to official coding guidelines, NCCI edits, CPT Assistants, Coding Clinics, and relevant payer and regulatory requirements. Monitor unbilled accounts and work with the AR team to reduce AR days and improve revenue cycle efficiency. Research unpaid claims. Contact patients to obtain necessary information to assist with the claims process. Secure payments or negotiate payment plans. ? Review assigned outstanding A / R to identify problems with various insurance payers (i.e. Medicare, Medicaid, Commercial Contracts and Self-Pay). Perform all routine and special follow-up on all assigned payer type accounts that affect collection of patient and insurance account balances.

Requirements

C. MINIMUM EDUCATION AND EXPERIENCE High school diploma or equivalent required. Minimum of 2 years of directly related experience in medical billing and coding. CPC (Certified Professional Coder) certification required within one year of hire. Proficient in Microsoft Office Suite (Word, Excel, Outlook). Experience billing across multiple disciplines, including medical primary care, behavioral health, OB / GYN, and pediatrics. Familiarity with various reimbursement methodologies, such as Prospective Payment System (PPS), Fee-for-Service (FFS), and third-party billing agreements. Experience handling both in-network and out-of-network claims, including submissions and aged accounts receivable. Strong analytical skills are essential to reduce AR days and enhance overall financial performance. D. KNOWLEDGE, SKILLS AND ABILITIES REQUIRED Proficient in assigning ICD-10-CM, CPT, and HCPCS Level II codes for a variety of outpatient services. Strong understanding of insurance billing procedures and third-party payer requirements. Technical proficiency in billing systems and electronic health records. Excellent verbal and written communication skills for effective interaction with providers and patients. Ability to analyze billing issues, identify trends, and recommend solutions to improve operational accuracy and financial performance. A. PHYSICAL CHARACTERISTICS / WORKING CONDITIONS

A person in this position has sufficient time to complete most tasks although under pressure depending on organization demands. There are frequent opportunities to relax from any physical exertion or to change position in work activities. 1. Physical Effort and Dexterity : Good dexterity to operate personal computer, and basic office equipment. Moderate physical activity expected. Requires handling of average-weight objects up to 25 pounds or standing and / or walking for more than four (4) hours per day. 2. Machines, Tools, Equipment required to be operated : office machines and personal computers for word processing, data entry and retrieval.