What are the responsibilities and job description for the Certified Biller Coder Specialist position at Bakersfield American Indian Health Project?
Summary / Objectives of Position
The Certified Biller & Coder Specialist's responsibility is to ensure the smooth facilitation of communication with funding sources, program partners, and insurance companies. This position will spend most of the time interpreting patient files and using established systems that make it easy for insurers to recognize the type of treatment covered under a patient’s plan. The day-to-day work of the Certified Biller & Coder Specialist includes proper coding of services, procedures, diagnoses, and treatments. Preparing and sending invoices or claims for payment. It is the responsibility of the position to gather documentation to validate the coding choices and argue against any wrongfully denied claims. They analyze all parts of a patient’s visit, including diagnostic tests, consultations, in-office procedures, and prescribed medication.
Essential Duties, Functions & Responsibilities
- Works with the Finance area in overseeing the operations of the billing area which encompasses medical coding, charge entry, claims submissions, payment posting, accounts receivable follow-up, and reimbursement management.
- Responsible for ensuring that codes are assigned correctly and sequenced appropriately as per government, program, and insurance regulations.
- Ensures compliance with medical and behavioral health coding guidelines and policies.
- Responsible for receiving and reviewing patients’ health records and documents, verifying for accuracy.
- Following up and clarifying any information that is not clear to providers and other staff members.
- Collects information made by the provider from different sources to prepare monthly reports and support BAIHP tracking and utilization reporting. Compiles accurate statistical reports.
- Responsible for working with management in the implementation of strategic procedures and choosing strategies and evaluation methods that provide correct results.
- Responsible to the translation of healthcare services, procedures, diagnoses, and treatments into standardized codes using systems like CPT, HCPCS, ICD-10-CM, and ASA.
- Regularly prepares and submits claims to funding agencies and insurance companies or other payers.
- Responsible for the review and correction of rejected claims.
- Responsible for the preparation and invoicing to patients, and working with them to create payment plans.
- Responsible for the tracking and collecting of payments, and post them to patient accounts.
- Ensures regular follow-up with patients and insurance companies regarding outstanding bills and claims.
- Supports effective systems and processes regarding billing by conducting regular audits and reviews of claims for services rendered.
- Ensures the accuracy of patient records.
- Responsible for the preparation of deposits.
- Works with the Medical Director in examining any medical malpractice issue reported by analyzing and identifying the medical procedures, diagnoses, or events that lead to the negligence
Minimum Mandatory Qualifications :
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Benefits Offered at BAIHP :
At BAIHP, we value our employees and strive to provide comprehensive benefits to support their well-being, financial security, and work-life balance. Here's what we offer :
