Certified Coding Specialist Job – Dallas, TX

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Why You'll Love This Job

General Description

This position is responsible for collecting payments from third-party medical, dental, and behavioral health payors. Collections activities include denial research, preparing & submitting appeals, and following up on unpaid, partial paid, or incorrectly paid claims. This includes identifying consistent payer-related payment delays, systematic denials, and communicating patterns to management. Collections Specialists will also support registration and insurance changes.

Responsibilities

Job Responsibilities

Specific Responsibilities Of The Job

• Monitor claims status for prompt and accurate payment. Follow up on, correct, and/or re-submit rejected, denied, partially paid, and incorrectly paid medical, dental, and behavioral health claims to insurance carriers in a timely manner. Ensure proper documentation is attached to corrected claims, if needed.
• Respond to payor correspondence; secure and submit additional documentation required or requested by insurance carriers.
• Identify coding, billing, and/or payment errors from EOB/ERA and make indicated corrections.
• Identify consistent payer delays, systematic denials, and other patterns and communicate them to management.
• Demonstrate and apply thorough understanding of insurance plan, Medicare, and Medicaid contracted rates, terms, and regulations to identify inaccurate payments and/or adjustments.
• Investigate, analyze, and resolve denials from insurance carriers.
• Understand and Analyze EOB/ERA information, including co-pay, deductible, co-insurance, coordination of benefits, contractual adjustments, denials, etc. to verify accuracy of insurance payments and patient balances
• Post charges, payments, adjustments, etc., as assigned.
• Maintain current knowledge on insurance carrier billing requirements and changes
• Accurately and timely update insurance, payment, and claim activity information in EHR/billing system. Demonstrate thorough understanding and effective, accurate use of the EHR/billing system.
• Collaborate effectively with patients, providers, and staff as needed to obtain needed information and to continually improve organizational billing and collections performance.
• Other duties as assigned.
  
  

Skills & Qualifications

Required Knowledge, Skills and Abilities:

• Detail-oriented, independent critical thinking and problem solving skills.
• Demonstrated ability to handle multiple responsibilities and meet tight deadlines in a complex environment.
• Demonstrated knowledge of medical, dental, and/or behavioral health provider reimbursement, medical terminology, ICD-10, CPT, and HCPCS coding.
• Proficiency in MS Word, Excel, and Outlook. Experience with MS Teams preferred.
• Excellent written and oral communication skills.
• Excellent technical and business acumen.
  
  

Education And Experience

• High school or equivalent education required. Associate's degree, Medical Assistant training, or other relevant certificates, certifications, or post-secondary education preferred.
• Minimum of 3 years’ experience in medical collections (medical, dental, and/or behavioral health); billing; coding; and/or denials management required.
• Medical and/or Dental Coding Certification required.
  
  

Preferred Qualifications:

• Experience with Athena Centricity, athenaOne, or other Athena products preferred
• Billing/coding/collections experience in a primary care or multi-specialty ambulatory setting preferred
• Work experience in a Federally Qualified Health Center (FQHC) or FQHC look-alike a plus.
  
  

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