Objective: Review coding, scrub claims to optimize reimbursement and ensure coding compliance before submitting to payors.

Skills needed include:

1. Nextgen preferred (or similar E.H.R)

2. Excel – pivot tables, analysis

3. Power BI proficiency is a plus but not required

4. ICD-10 Coding Skills: Strong understanding of ICD-10 coding guidelines and the ability to accurately apply ICD-10 codes to medical diagnoses and procedures.

5. Minimum 5 years coding & billing experience

6. Minimum 4 year degree in finance related field

7. Should have one of the following certifications or a similar professional certification:

a. Certified Professional Coder (CPC)** - Offered by the American Academy of Professional Coders (AAPC).

b. Certified Coding Specialist (CCS)** - Provided by the American Health Information Management Association (AHIMA).

c. Certified Coding Specialist—Physician-based (CCS-P)** - by AHIMA.

d. Certified Medical Billing Specialist (CMBS) Medical Association of Billers

e. Certified Professional Biller (CPB)** - Offered by the AAPC.

f. Certified Outpatient Coder (COC)** - Offered by the AAPC.

Job Duties include:

1. Review Provider Coding**: Ensure that all provider coding submissions are reviewed within 48 hours to confirm accuracy and optimization of CPT and ICD-10 codes.

2. Training and Feedback**: Provide coding training and feedback to providers to enhance coding efficiency and accuracy.

3. Proficiency on Electronic Medical Records/Reporting Platforms**: Demonstrate proficient navigation and use of Nextgen for all billing and coding processes.

4. Submit Medical Necessity Information**: Prepare and submit necessary medical documentation, including medical records to support billing.

5. Liaison with Billing Company**: Act as the primary contact with the billing company on issues such as billing, payment postings, adjustments, and account follow-ups.

6. Accounts Receivable Management**: Work closely with the billing company to ensure that payments and adjustments are posted timely.

7. Pull and Post Payment Information**: Access insurance payer portals to retrieve payment information and post it to Nextgen.

8. Generate Billing & RCM Reports**: Produce regular reports for the Finance Department/CFO, including Aging Reports, Billing Productivity, KPIs, Billing Reports, and Denial Management Reports. Most of these reports will come from Nextgen but candidate must have Excel proficiency to create Excel data analysis from the Nextgen reports.

9. Submitting and Managing Claims**: Handle claim submissions and re-submissions, including preparing, updating, and renewing all Participating Provider Agreement forms and documents.

10. Resolving Denied Claims**: Research denied claims to determine validity, appeal unjustified denials by gathering supportive information from medical records, and collaborate with the coding department for necessary coding adjustments.

11. HIPAA Compliance**: Maintain a comprehensive understanding of HIPAA regulations to ensure compliance in all processes.

This position reports to the CFO and is part of the Finance Dept. This position must also work very closely with the Practice Manager & Clinical Director.

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