The Certified Coder performs a wide range of duties, including filing claims to secondary insurance carriers, conducting research and follow-ups on claims that are rejected by insurance companies and analyzing billing errors.
- Maintains accurate patient accounts including deductibles, co-payments, co-insurance, termination dates, effective dates, pending claims, etc.
- Processes claims for secondary insurance companies and conducts research on any claims denied by insurance companies. Matches remit copy with hard copy claim. Keys in account numbers. Checks balances due from secondary insurance companies. Verifies benefit determinations.
- Initiates appeal process for denied claims.
- Processes all monetary transactions in an appropriate manner and reports daily to supervisor.
- Assists patients in a professional and courteous manner with their questions and concerns.
- Works with insurance companies to verify patient information or to adjust claims.
- Works insurance tracking report to ensure insurance companies process claims in a timely manner. Tracks refilled claims; ensures accounts are followed up on in a timely manner.
- Codes and abstracts all diagnoses and procedures according to ICD-9-CM and CPT-4/HCPCS hospital coding policies and procedures, and Federal and State Coding and reimbursement guidelines with 95% accuracy.
- Initiates physician interaction when ambiguous or conflicting information is in the medical record.
- Exhibits knowledge and aptitude regarding coding software and resources for accurate code assignment.
- Provides backup to other members of department as needed.
- Education: High School diploma or equivalent.
- Licensure/Certification: Coding certification required.
- Experience: Minimum of one year experience in hospital or physician practice medical billing/insurance required. Minimum of one year of ICD-9, medical terminology and CPT coding experience preferred.