Description:
Position Title: Certified Coder/Medical Biller
Reports to: Revenue Cycle Manager
Primary Location: Georgetown – (incumbent may be transferred or asked to report to any of LRHC’s locations based on the needs of the organization)
Wage Classification: Non-Exempt
Job Summary: The Medical Coder/Biller is responsible for accurate coding, billing, payment posting, and follow-up of medical claims. This position plays a critical role in ensuring timely reimbursement, compliance with federal and state regulations, and adherence to FQHC-specific billing requirements, including sliding fee scale policies
Essential Responsibilities:
The following duties are not intended to serve as a comprehensive list of all duties performed by all associates in this position. The duties listed are intended to provide a representative summary of the major duties and responsibilities. The incumbent may be required to perform additional, position-specific duties as assigned by their manager and/or LRHC Leadership.
Coding & Claims Submission
- Review coding denials for incorrect/expired CPT, HCPCS, and ICD-10 codes in accordance with payer and FQHC guidelines
- Assist providers with correct coding by providing feedback and clarification on documentation and coding requirements
- Identify coding errors, trends, or opportunities for improvement and recommend corrective actions
- Notify the Revenue Cycle Manager of repeated or significant coding errors and participate in corrective action planning
- Prepare, review, and submit clean claims to commercial insurers, Medicaid, Medicare, and other third-party payors
- Ensure claims are submitted in a timely manner and in compliance with federal, state, and payer regulations
- Supports Coding audits
Payment Posting & Electronic Payments
- Ensure accurate posting of contractual adjustments, write-offs, and patient responsibility amounts
- Work in Clearing house to submit and correct claims.
- Balance posted payments against bank deposits and remittance reports
- Research and correct posting errors in a timely manner
- Coordinate refunds and credit balance resolution in accordance with organizational policies
- Post payments accurately from insurance payors and patients into the practice management system
- Download and process electronic remittance advice (ERA) and electronic funds transfers (EFT)
- Identify and resolve payment discrepancies, underpayments, and overpayments
Denials Management & Follow-Up
- Work assigned claim denials, rejections, and unpaid claims, including researching payer policies, eligibility issues, authorization requirements, and coding-related denials
- Review explanation of benefits (EOBs) and remittance advice to determine denial reasons and appropriate corrective actions
- Correct and resubmit denied or rejected claims in a timely manner to meet filing limits
- Prepare, submit, and track insurance appeals with required documentation and supporting medical records
- Communicate with insurance payors via phone, portals, and correspondence to resolve complex or aged denials
- Analyze denial trends, research root causes, and prepare corrections or appeals as needed
- Follow up with payors to ensure timely resolution and maximum reimbursement
- Work AR aging reports provided by the Revenue Cycle Manager
Sliding Fee Scale & Patient Accounts
- Apply sliding fee scale adjustments in accordance with FQHC policies and federal guidelines
- Ensure patient charges and adjustments are calculated accurately based on income eligibility
- Collaborate with front desk and eligibility staff to resolve patient account issues
- Support Audits on Sliding Fee Scale
Compliance & Reporting
- Maintain compliance with HRSA, CMS, and payer billing requirements
- Support internal and external audits by providing documentation and billing clarification
- Communicate billing issues, trends, and process improvement opportunities to the Revenue Cycle Manager
Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or competency required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
- Certified Professional Coder (CPC) certification
- High school diploma or GED required
- Minimum 10 years of medical Coding and Billing experience in an FQHC or community health center
- Minimum 7 years of experience working Clearing house systems
- Working knowledge of CPT, ICD-10, HCPCS, and payer reimbursement methodologies
- Experience in FQHC coding, medical billing, health information management, or related field
- Experience with Medicaid, Medicare (including PPS for FQHCs), and commercial insurance billing
- Experience with electronic health record (EHR) and practice management systems
- Familiarity with HRSA and FQHC compliance requirements
Education and/or Experience:
- High School Diploma or GED required.
Language Skills:
English proficiency
Skills and Competencies:
- Strong attention to detail and analytical skills
- Ability to manage multiple priorities and deadlines
- Excellent written and verbal communication skills
- Ability to work independently and as part of a revenue cycle team
- Proficiency in Microsoft Office, Teams, Coding and Billing software
Equipment Operated:
Wide range of office equipment. Computer use and proficiency required.
Mental/Physical Requirements:
- Sitting for long periods while using a computer
- Ability to focus for sustained periods with minimal supervision
Requirements:
Compensation details: 24-26.44 Hourly Wage
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