Title: Certified Coder/AR Specialist

  • Department: Finance
  • Type: Full Time
  • Location: Houston, TX

Certified Coder/AR Specialist

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About the Position

Certified Coder Performs evaluation/management and procedural coding for clinic, inpatient, and outpatient encounters. Assigns and sequences all codes for services rendered. Contacts physicians and other health care professionals with questions about treatments or diagnostic tests given to patients with regard to coding procedures. Communicates with practice billing staff regarding denied claims to resolve.

Accounts Receivable Specialist reviews and researches patient accounts and claims that have not yet paid. They also submit documentation and letters for appeals, redeterminations and audits. Account receivable specialist must have a strong background in insurance collections and be able to work large volume of accounts on a daily basis. 

Essential Functions and Duties

  • Reviews and interprets health record documentation to identify pertinent diagnosis/procedures that require code assignment for inpatient and outpatient.
  • Demonstrates appropriate utilization of coding software and coding reference material.
  • Abstracts pertinent information from patient medical records.
  • Updates all rejected claims within the our clearing house
  • Communicates with physicians and managers of any problems arising from incorrect, incomplete coding or documentation
  • Maintain a close working relationship with physicians, advanced practice providers, and billing clerks, in regards to coding and billing
  • Daily follow up on all outstanding insurance and patient claims they are responsible for.
  • Work daily rejections generated by the clearinghouse and insurance carriers.
  • Post contractual adjustments and transfer deductibles to patient accounts based on correspondence from the insurance carriers.
  • Assist with claim resubmission when necessary.
  • Coordinate with management to streamline billing procedures based on denial types.
  • Contact insurance companies on unpaid claims.
  • Review accounts that have partial or under payments.
  • Responds to patient billing and statement inquiries
  • Handle correspondence from insurance companies including denials, information and/or refund requests.
  • Prepare and submit insurance claims, appeal letters and reconsiderations
  • In depth comprehension of the rules, regulations, payment reconsiderations appeal process and timely filing regarding insurance billing, coverage and collections process and the ability to apply that knowledge on a daily basis
  • Other duties as assigned
  • Maintain the strictest confidentiality
  • Communicate clearly, openly and effectively

Position Requirements:

  • Education

    • High School Diploma or equivalent
    • Prefer Associates degree in Medical Billing and Coding or Accounting
  • Certifications, Licenses, and Registration
    • Possess a valid TX driver license
    • Medical coding certification is required (A Certified Coder Associate working toward a Certified Coder Specialist certification will be considered)
  • Skills and Attributes
    • 4 year minimum experience as a medical biller
    • Must maintain CPC membership
    • Must complete and submit to NL and certifying agency the required continuing education units
    • Knowledge of medical billing, CPT, and ICD 9/10 and medical terminology.
    • Knowledge of Medicare and Medicaid guidelines
    • Knowledge of medical insurance payers, billing rules and regulations.
    • Strong communication, problem solving and analytical skills
    • Ability to read and understand denials to determine correct reimbursement.
    • Ability to maintain daily productivity standards
    • Knowledge of out of network claims reimbursements and payments.
    • Knowledge of examination, diagnostic and treatment room procedures
    • Knowledge of insurance guidelines; including Medicare and Medicaid
    • Skill in identifying and resolving problems
    • Proficient in EMR Systems
    • Proficient in Microsoft Office Suite and other software
    • Ability to use good reasoning and judgment and react calmly in emergency situations
    • Ability to establish and maintain effective working relationships with patients, co-workers and vendors
    • Ability to read, write and communicate effectively with oral and written correspondence
    • Proficiency in the operation of a computer and other office equipment
    • Ability to remain focused and productive each day though tasks may become repetitive
    • Microsoft Windows - Intermediate in Microsoft Word and Excel
    • Must be able to attend quarterly staff meetings (4 Saturdays/year) and Front office/Billing meetings as necessary

NightLight Pediatric Urgent Care is an equal opportunity employer.

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