Certified Professional Coder/Biller

Certified Professional Coder/Biller

Job Summary:

We are seeking a Certified Professional Coder/Biller to join our Rural Health Clinic (RHC) team. The ideal candidate will be responsible for accurately coding medical procedures, diagnoses, and services while ensuring compliance with RHC billing regulations. This role involves claim submission, payment posting, follow-ups on denials, and working closely with providers and payers to optimize reimbursement.

Key Responsibilities:

Medical Coding & Billing:

• Assign appropriate CPT, HCPCS, and ICD-10 codes for services provided in the clinic.
• Ensure compliance with Rural Health Clinic (RHC) billing guidelines and Medicare/Medicaid regulations.
• Submit and process claims electronically and manually, as needed.
• Review provider documentation to ensure accurate coding and medical necessity.

Claims & Reimbursement:

• Track claims from submission through payment and follow up on unpaid or denied claims.
• Identify and resolve billing errors, discrepancies, and denials.
• Reconcile accounts and ensure proper reimbursement from government and private payers.
• Work with insurance companies to resolve claim rejections and denials.

Compliance & Documentation:

• Stay updated on changes in coding and billing regulations, especially those related to RHCs.
• Maintain compliance with HIPAA, CMS, and other relevant regulatory guidelines.
• Conduct internal audits to ensure coding accuracy and compliance.
• Assist with provider education on documentation best practices.

Patient & Provider Support:

• Communicate with patients regarding billing inquiries, payment plans, and financial assistance options.
• Collaborate with providers and clinical staff to ensure accurate coding and charge capture.
• Provide training and support to staff on coding, billing processes, and payer requirements.

Qualifications & Skills:

• Certification Required: CPC (Certified Professional Coder), CCS-P, or equivalent certification.
• Experience: Minimum of 2 years in medical coding and billing, preferably in an RHC setting.
• Strong knowledge of RHC billing rules, Medicare/Medicaid guidelines, and commercial insurance processes.
• Proficiency in EHR/EMR and billing software (e.g., Athenahealth, eClinicalWorks, EPIC, or similar).
• Strong understanding of medical terminology, payer guidelines, and coding compliance
• Excellent problem-solving skills and attention to detail.
• Strong communication and customer service skills.
• Ability to work independently and as part of a team.

Preferred Qualifications:

• Familiarity with UB-04 and CMS-1500 claim forms.
• Experience with RHC cost-based reimbursement methodologies.
• Knowledge of telehealth billing and rural health initiatives.
• Prior experience in account receivables management and collections.

Benefits:

• Competitive salary based on experience
• Health, dental, and vision insurance
• 401(k) with employer matching
• Paid time off (PTO) and holidays
• Continuing education and certification reimbursement

If you are a detail-oriented Certified Professional Coder/Biller looking for an opportunity to contribute to a thriving Rural Health Clinic, we encourage you to apply!

To Apply: Submit your resume and cover letter.