Certified Coder/ Biller

Job Title: Certified Medical Coder/Biller

Location: Richmond Hill, GA | Hybrid Remote

Employment Type: Full-time

Reports to: Billing Manager

Department: Revenue Cycle Management

Job Summary: 

The Certified Medical Coder/Biller is responsible for accurately submitting claims to insurance companies, ensuring timely reimbursement for medical services provided by the healthcare facility. This role involves reviewing patient bills for accuracy and completeness, resolving any billing issues, and communicating effectively with patients, insurance companies, and healthcare providers. The ideal candidate will have strong attention to detail, excellent organizational skills, and a solid understanding of medical billing processes and insurance guidelines.

Key Responsibilities:

1.   Claims Processing:

· Prepare and submit accurate and timely insurance claims for services rendered.

· Verify patient insurance coverage and ensure correct billing to the appropriate payer.

· Review and process Explanation of Benefits (EOBs) and insurance payments.

2.   Billing and Coding:

· Ensure that all medical services are accurately coded according to current guidelines (CPT, ICD-10, HCPCS).

· Work closely with healthcare providers to ensure that documentation supports the services billed.

· Resolve discrepancies or issues with coding and billing practices.

3.   Payment Posting:

· Post payments and adjustments to patient accounts accurately.

· Reconcile daily billing activities and ensure all transactions are properly recorded.

· Monitor and follow up on unpaid claims and patient balances.

4.   Patient Communication:

· Respond to patient inquiries regarding billing and insurance coverage.

· Explain billing policies and procedures to patients and assist with payment arrangements if needed.

· Resolve patient billing complaints in a professional and timely manner.

5.   Insurance Follow-Up:

· Track and follow up on outstanding claims to ensure timely payment.

· Appeal denied claims and work with insurance companies to resolve issues.

· Maintain detailed records of claim statuses and correspondence with insurance providers.

6.   Compliance:

· Ensure compliance with all federal, state, and local regulations, as well as organizational policies and procedures.

· Stay current on industry changes and updates related to medical billing, coding, and insurance regulations.

· Participate in internal audits and implement corrective actions as necessary.

7.   Reporting:

· Generate and analyze billing reports to monitor revenue cycle performance.

· Provide regular updates to management on billing activities, challenges, and successes.

· Assist in the preparation of financial reports related to billing and collections.

 Work Environment:

• Office Setting: This position can work in an office setting with standard hours.
• Remote Work: We do offer a hybrid schedule if interested. 
• Physical Requirements: Ability to sit for extended periods, use a computer, and perform repetitive tasks.

Compensation and Benefits:

• Competitive salary based on experience.
• Comprehensive benefits package, including health and dental insurance.
• Paid time off (PTO). 
• Opportunities for professional development and advancement.

Qualifications:

• High school diploma or equivalent; Associate’s degree in a related field preferred.
• Certification in Medical Billing and Coding (e.g., CPC, CCA) is required.
• Minimum of 2 years of experience in medical billing or a related role.
• Strong knowledge of insurance guidelines, including Medicare and Medicaid.
• Proficiency in medical billing software and electronic health records (EHR) systems.
• Excellent communication and interpersonal skills.
• Ability to work independently and manage multiple tasks effectively.
• High level of accuracy and attention to detail.
• Strong problem-solving skills and ability to handle billing issues professionally.