JOB TITLE: Certified Professional Coder

NOTE: Must be CPC Certified via AAPC

SUMMARY: The Certified Professional Coder at Progressive Spine & Orthopaedics plays a crucial role in ensuring accurate and timely processing of medical bills. Responsibilities include reviewing patient records, assigning accurate medical codes, submitting claims to insurance companies, and following up on unpaid claims. The specialist must stay updated with coding guidelines and regulations to ensure compliance. Additionally, they work closely with healthcare providers and insurance companies to resolve billing discrepancies and ensure efficient reimbursement processes. 

DUTIES AND RESPONSIBILITIES:

• Identify billing errors for corrections and resubmit claims to insurance carriers. 
• Follow up on payment errors, low reimbursement, and denials. 
• Compile, code, and submit patient insurance claims to insurance companies as well as follow up on all claims from charge entry through resolution. 
• Review insurance EOB’s and initiate appeals as necessary.
• Respond and appeal to medical necessity denials. 
• Updating system errors, noting system, researching insurance guidelines.
• Follow protocol to determine best course of action to follow up on open receivables.
• Research root issue of denial. Apply knowledge of payer policies to pursue proper course of appeal or follow up to obtain payment.
• Review account history for continuous follow up. 
• Contact insurance companies and/or patient/guarantor through phone contact, correspondence, online portals and other approved means to obtain status of outstanding claims and submitted appeals. 
• Documents clearly in billing system the claim issue and course of action taken on every account worked. Documentation and action must be clearly noted for future follow up and review. 
• Escalate issues and problems to supervisor as appropriate. 
• Identify trends or patters of persistent problems. 
• Perform charge corrections based on payer and institutional policies. 
• Negotiate out-of-network reimbursement, based on determined criteria for max reimbursement.
• Perform other related duties as assigned by management. 

QUALIFICATIONS: 

• High school diploma or equivalent.
• Certified Professional Coding Certification (CPC) from AAPC required.
• Three to five years experience with ICD-10, insurance collections and processing out-of-network claims.
• Excellent written and oral communication skills.
• 10-key by touch; keyboarding speed of at least 50 wpm.
• Knowledge of medical billing terminology.
• Ability to perform diversified clerical functions and basic accounting procedures.
• Ability to effectively communicate with people at all levels and from various backgrounds.
• Commitment to excellence and high standards.
• Strong organizational, problem-solving, and analytical skills.
• Ability to manage priorities and workflow.
• Acute attention to detail.
• Ability to work independently and as a member of various teams and committees.
• Proven ability to handle multiple projects and meet deadlines
• Bilingual skills a plus.

BENEFITS:

• Competitive salary and benefits package
• Health, dental, and vision insurance
• Retirement Plan
• Employee Assistance Program
• Paid Time Off
• Opportunities for professional development and growth
• Collaborative and supportive work environment

Progressive Spine & Orthopaedics is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.