Certified Coder/Biller

The Certified Coder reviews, analyzes, and codes diagnostic and procedural information that determines Medicare, Medicaid, and private insurance payments. This role is responsible for coding, charge entry, accounts receivable follow-up, and reimbursement management. It also ensures compliance with established coding guidelines, third-party reimbursement policies, regulations, and accreditation guidelines.

Key responsibilities include:

• Assign and sequence diagnosis and procedure codes from documented information
• Review records to ensure final diagnoses and operative procedures are valid and complete
• Abstract information and assign codes that most accurately describe documented diagnoses, procedures, and special therapies
• Review medical records for required components, documentation consistency, and adequacy
• Assign appropriate Evaluation & Management levels using the correct CPT code
• Work with Clinical Operations to ensure new programs and services are billable
• Ensure billable activities comply with protocols, government rules, and payer regulations
• Maximize reimbursement in a cost-effective manner
• Serve as a resource for fee schedule and coding guideline changes
• Troubleshoot and resolve patient revenue cycle issues and recommend improvements
• Support organizational mission, faith statement, and core values
• Perform other duties as needed