Certified Medical Coder (on site)

Anderson Hills Pediatrics’ Expectations of all Employees: 

• Adhere to all Anderson Hills Pediatrics’ Policies and Procedures
• Conduct self in a manner that represents Anderson Hills Pediatrics’ core values at all times
• Maintain a positive and respectful attitude with all work-related contacts
• Consistently reports to work prepared to perform the duties of the position
• Meets productivity standards and performs duties as workload necessitates

 Primary Function: Assists the Billing Manager with the claims submission and revenue cycle of the practice.

Major Duties and Responsibilities: 

• Adherence to current HIPAA regulations and federal/state laws for patient protected health information (PHI) and/or medical records; adherence to all AHP policies/procedures as they pertain to patient PHI and the medical record; maintain strict confidentiality of all patient information 

• Update patient demographic information including insurance coverage; make changes/corrections as needed; verify patient insurance benefits when applicable 

• Process required referrals to specialists and/or facilities 

• Audit charges from EMR for accuracy in CPT /ICD-10 / HCPCS coding 

• Pursue any outstanding claims and/or appeal any denied or underpaid claims 

• Respond to requests for medical records from insurance companies 

• Post patient and/or insurance remittances 

• File insurance claims daily 

• Perform daily close of the day 

• Investigate, analyze, and follow up for collection of overdue accounts 

• Initiate and respond to telephone inquiries from patients, insurance companies, others 

• Process BCMH applications as needed 

• Participate in quality improvement initiatives as needed 

• Complete necessary training on topics including, but not limited to, care coordination, patient self-management, population management, and health literacy 

• Attend monthly staff meetings and scheduled department meetings 

• Other miscellaneous duties as assigned by the Billing Manager 

 Principle Working Relationships 

• Works with patients/families, insurance companies and Finance Manager 
• Works with physicians, other managers, and staff as needed 

 Qualifications: 

• Education: High school diploma 
• 1-3 years of medical billing office experience preferred 
• Coding certification required 
• Experience in pediatrics preferred 

 Essential Skills and Abilities:

• Demonstrate excellent listening skills and problem-solving skills 
• Ability to interpret, adapt and apply guidelines and protocols 
• Ability to willingly invest in change processes to improve efficiencies, compliance, and overall AHP performance 
• Exceptional interpersonal skills, including the ability to establish and maintain effective relationships with physicians, other employees, and patients
• Excellent critical thinking skills; exhibit sound judgment in decision making
• Excellent communication (both oral and written)
• Demonstrate strong customer service skills, including the ability to use appropriate judgment, independent thinking, and creativity when resolving customer issues
• Initiative and ability to work independently, lead/work in teams, and deal persuasively and effectively with all levels throughout the organization.
• Ability to manage multiple projects in varying stages of development; excellent problem-solving skills and attention to detail.
• Must be able to receive constructive criticism and react quickly to change.
• Ability to balance and shift multiple priorities.

Working Conditions: 

• Works in clinical areas as well as throughout the facility
• Sits, stands, bends, lifts and moves intermittently during work hours
• Relocation not available