Requirement Education and Experience: High School graduate or equivalent. A current Certified Professional Coder Certification (CPC). Two to three years’ experience in a medical business office or related field. Experience with the claims adjudication process for multiple governmental agencies and private insurance Carriers. Current CPT and ICD10 coding knowledge, and basic medical terminology. Experience supervising and motivating staff to meet/exceed productivity and quality standards while maintaining a positive work environment.

Additional Eligibility Qualifications: Use interpersonal skills effectively to communicate with internal and external customers to resolve claim adjudication issues. An aptitude to retain detailed information. Ability to be multi-tasked oriented, to prioritize and to produce an acceptable volume of work. Excellent organizational and problem-solving skills. Excellent communication skills, oral and written. Basic knowledge of Windows-base computer applications. Accurate typing rate of 40 wpm. Ability to operate the following equipment: computer, copier, fax, and 10-key Calculator.

Essential Functions:

Responsible for the day to day supervision of staff. Assists the department Manager in the direction and training of staff and performs additional duties as assigned.

Exercise good judgment in decision making. Considers all facts and makes sound decisions based on a thorough analysis of the issue. Addresses employee issues effectively and responds in a professional manner.

Receives and processes the electronic submission exception report. Verifies confirmations on daily transmissions. Identify reasons claims did not file and take appropriate action to correct errors.

Works to resolution disputes and appeals of third-party denials. Identifies, reviews and corrects denials for inappropriate payments. Reviews claims for completeness and compliance with established Medicare billing guidelines. Contests charges that are not paid or underpaid. Accesses available third party and governmental on-line services.

Documents all actions taken within the systems.

Possesses a comprehensive understanding of Clinic contracts, carrier specific, State or Federal governmental, HCFA, or CPT billing and reimbursement guidelines. Review bulletins, updates, etc., and maintains applicable guidelines as reference/ resource material.

Reviews and monitors the Aged Trial Balance, ETM, daily claims and cases within the department.