***This position is not remote***
POSITION SUMMARY:
Under the direct supervision the Billing Manager, the Medical Coder should understand NAC policies and all funding sources and contracts. The Coder reviews the physicians and clinician documentation for accuracy of claims submissions. Coder must have knowledge of ICD-10, CPT, HCPCS diagnostic and procedural codes
RESPONSIBILITIES:
- Reviews medical and behavioral claims for correctness of claims utilizing the ICD-10, CPT and HCPT code set.
- Prepares and submit claims for Medicare, must have knowledge of Medicare coding guidelines.
- Maintains communication providers to ensure timely notification of identified documentation issues that may impact revenue or compliance.
- Reviews all prior authorization received and attach to services for billing
- Create invoice and send to Tribal payor source, post payment when received in EHR.
- Analyze and monitoring denied claims; make appropriate adjustments for resubmissions or prepare for write offs.
- Make collections calls to payors for claims not paid after 60 days.
- Reconciling invoices with balance sheet reports and resolving any discrepancies. Complete and close any claims not paid within 90, prepare for charge off
- Attends quarterly meeting for MCOs, TRBHAs or RBHAs
- Works with Billing Manager on updating fee schedule and making updates according to CMS, and Medicaid changes.
- Other duties as assigned
EDUCATIONAL REQUIREMENT
- High School or GED required.
- CPC(Certified Professional Coder), COC(Certified Outpatient Coder) or CCS(Certified Coding Specialist) or other qualified certification from an AAPC or AHIMA required.
WORK EXPERIENCE/SKILLS REQUIREMENT
- Knowledge of assigning and sequencing ICD-10, CPT, HCPC and modifiers codes.
- Knowledge of medical terminology, anatomy and physiology, knowledge of medical records requirements, HIPAA privacy rules.
- Working knowledge of Medicare, NCCI(National Correct Coding Initiative), LCD(Local Coverage Determination) and NCD(National Coverage Determination) and other claims edits.
- Familiarity with Medicare, Medicaid and other private insurance requirements.
- Experience in AHCCCS enrollment and benefit verification processes
- At least two years coding in a medical office
- Knowledge of HIMS/AXIOM preferred, or other EHR software
- Highly detail oriented
- Must be a team player, possess a strong work ethic and be able to coordinate multiple tasks while meeting require deadlines
- Possess excellent customer service, communication, organizational and interpersonal skills
- Excellent communication skills – written and oral
- Experience in working with the Native American population preferred
- Proficiency in MS Office, particularly Excel
FAIR LABOR STANDARDS ACT:
This position is considered to be Non- Exempt for overtime pay provisions as provided by the Federal Fair Labor Standards Act (FLSA) and any applicable state laws. Non-Exempt employees are entitled to overtime pay for hours worked in excess of forty (40) hours per work week.
NATIVE AMERICAN PREFERENCE: Preference is given to qualified Native American Applicants in accordance with the Indian Preference Act. If claiming a preference, a copy of valid documentation will be necessary.
EEO/AA
FAIR LABOR STANDARDS ACT:
This position is considered to be Exempt for overtime pay provisions as provided by the Federal Fair Labor Standards Act (FLSA) and any applicable state laws.
This position is considered to be Non- Exempt for overtime pay provisions as provided by the Federal Fair Labor Standards Act (FLSA) and any applicable state laws. Non-Exempt employees are entitled to overtime pay for hours worked in excess of forty (40) hours per workweek.