Biller

Purpose: The Certified Professional Coder (CPC) is responsible for a variety of billing tasks relating to the efficient provision of medical services at Western Wayne Family Health Centers (WWFHC). These activities may include accurate coding, claim submission, payment posting, and follow-up correction or resubmission activities to ensure timely and compliant reimbursement and other duties as assigned by the Billing Manager. This role works closely with providers, billing staff, and payors to resolve coding and billing issues.

PART I: ESSENTIAL POSITION FUNCTION AND DUTIES

1. Responsible for maintaining a current knowledge of coding and diagnostic procedures and guidelines as well as being current regarding legislative changes related to billing and office practices.

2. Prepare, review, and submit clean and accurate claims to commercial, Medicaid, Medicare, and other third-party payors electronically and by paper when required.

3. Review clinical documentation to ensure accurate code selection, appropriate modifiers, and compliance with payer and regulatory requirements.

4. Collaborate with providers, office managers, and billing staff to resolve coding discrepancies and provide education or guidance on correct documentation and coding practices.

5. Perform accounts receivable (A/R) functions, including monitoring outstanding balances, issuing patient statements when applicable, and following established collection protocols.

6. Conduct collection activities, including contacting patients by phone or mail, responding to billing inquiries, and resubmitting claims to third-party payors as needed

7. Reconcile explanation of benefits (EOBs), remittance advices, and payments from insurance companies and other payors.

8. Post and process insurance payments, contractual adjustments, denials, and corrections accurately and timely within Athena.

9. Review, analyze, and report on the status of delinquent accounts, identifying trends and recommending corrective actions.

10. Identify, research, and resolve claim denials, rejections, and underpayments, ensuring timely resubmission and follow-up.

11. Perform patient and billing tasks within Athena, including claim edits, charge corrections, payment posting, and account adjustments.

12. Identify and resolve patient billing complaints professionally and in accordance with organizational policies.

13. Maintain strict confidentiality of patient and financial information in compliance with HIPAA and organizational policies.

14. Maintain accurate accounts receivable aging reports and support month-end reconciliation processes

15. Perform other duties as assigned to support billing operations and revenue cycle performance.

PART II: CLINIC WIDE RESPONSIBILITIES

1. Customer Relations:

a. Treats guests, patients, physicians, and other employees with care, courtesy, and respect.

b. Responds quickly and appropriately to customer request.

c. Looks for and suggests ways to better meet customer needs.

d. Answers clinic communications systems promptly with courtesy and respect.

2. Teamwork:

a. Works cooperatively within own department and other areas.

b. Willingly accepts additional responsibility – tries to make other’s job easier.

c. Responds quickly to request for assistance.

d. Required to work closely with patients and associates.

e. Interacts with other departments on problem issues.

f. Accepts feedback from patients, visitors, clinic employees, physicians and general public.

3. Continuous Improvement:

a. Continuously looks for and suggests ways to improve.

b. Effectively completes assignment to achieve the greatest benefits at acceptable cost.

c. Implements improvements as appropriate.

d. Demonstrates interest in own growth and development by:

(1) Periodically evaluating own performance.

(2) Demonstrating an awareness of personal abilities and limitations.

(3) Independently seeking means to make improvements.

(4) Attends and participates in in-services and continuing education programs

(5) Attends departmental meetings.

4. Communications:

a. Keeps appropriate people informed.

b. Speaks and writes clearly, concisely, and appropriately for need.

c. Listens carefully.

d. Communicates tactfully.

e. Understands that all confidentiality and privacy considerations are respected an 

fostered at work and off duty.

5. Self –Management:

a. Presents a positive image of WWFHC at all times.

b. Carries out assignments with little need for direction.

c. Timeliness.

d. Maintains confidentiality.

e. Provides proper notification of absence and tardiness.

f. Works weekends and shifts when necessary.

PART III: EDUCATION, EXPERIENCE

1. Education: Completion of a Billing and Coding program having earned a CPC or CPC-A which is active and in good standing.

2. Experience: One (1) year of experience in medical/dental business office with primary focus on insurance billing and coding practices. One (1) year of medical coding experience.

PART IV: KNOWLEDGE, SKILLS AND ABILITIES

1. Proficiency using EMR systems and Microsoft Office.

2. Preferred proficiency using Athena.

3. Knowledge of basic billing, coding and account management techniques.

4. Skilled with working in a complex work environment.

5. Ability to maintain confidentiality at all times and maintain organizationally appropriate relationships.

6. Knowledge of organization policies and procedures.

7. Knowledge of computer, systems, and medical billing applications.

8. Skilled in exercising initiative, appropriate judgment, problem-solving and decision making.

9. Skilled in developing and maintaining effective relationships with internal and external customers.

Working Conditions

Jobs are located in federally qualified health facility.

1. Education: Completion of a Billing and Coding program having earned a CPC or CPC-A which is active and in good standing.

2. Experience: One (1) year of experience in medical/dental business office with primary focus on insurance billing and coding practices. One (1) year of medical coding experience.