Medical Claims and Billing

Black Doctors Consortium • Philadelphia, PA • 1w ago

Medical Claims/Billing, or Certified Professional Coder, is responsible for reviewing a patient's medical records after a visit and translating the information into codes that insurers use to process claims from patients. Their duties include confirming treatments with medical staff, identifying missing information and submitting forms to insurers for reimbursement.

ESSENTIAL DUTIES and RESPONSIBILITIES:

The duties and responsibilities of a Medical Claims/Biller vary from one healthcare facility to another. The main duty of a Medical Claims/Biller is assigning codes to medical procedures and diagnoses. Other duties and responsibilities of a Medical Claims/Biller include:

Making sure codes are assigned correctly and sequenced appropriately as per government regulations

Complying with medical coding guidelines and policies

Receiving and reviewing patients charts and documents for verification and accuracy

Following up and clarifying any information that is not clear to other staff members

Collecting information made by the Provider from different sources to prepare monthly reports

Implementing strategic procedures and choosing strategies and evaluation methods that provide correct results

Sending completed charts to billing for payment

Medical Coders work at hospitals, clinics and other healthcare settings to facilitate communication with insurance companies. They spend most of their time interpreting patient files and manually updating them with medical codes. When assigning a code to a patient's file, Medical Coders use established systems that make it easy for insurers to recognize what kinds of treatment they cover under a patient's plan. Medical Coders also gather documentation to validate their coding choices and argue against any wrongfully denied claims. They analyze all parts of a patient's visit, including diagnostic tests, consultations, in-office procedures and prescribed medication.

SKILLS AND RESPONSIBILITIES:

Strong understanding of physiology, medical terms and anatomy

Proficiency in computer skills including typing speed and accuracy

Mathematics skills

Excellent written and verbal communication skills

Superb organizational skills

Ability to maintain a high level of integrity and confidentiality of medical information

Strict attention to detail

Knowledge of data entry and transcription

Strong ability to work quickly and accurately

EDUCATION and EXPERIENCE:

High School Diploma or higher education

Two (2) or more years' experience - certification preferred

Experience in Healthcare Information Management or related field of study

Superior Customer Service

Ability to maintain composure and convey a positive attitude while interacting with customers and the team

Good attendance and punctuality

Strong ability to multitask

Ability to work quickly and accurately

Excellent communication skills (written and verbal)

Ability to interact and communicate with internal and external professionals

Ability to work with minimal supervision

Candidates will have access to secure public safety information. All selected applicants must undergo and successfully complete a background investigation as a condition of placement in this position.

OTHER REQUIREMENTS:

A proficient Medical Coder should have experience with medical coding guidelines and procedures such as ICD-9, CPT, ARG and ASA, among several others.

Strong communication, both written and verbal

Great active listening skills

Exceptional interpersonal and rapport building skills

A patient and empathetic attitude

Strong time management and organizational skills

Adaptability and flexibility

Comfortable working in fast-paced environments

Troubleshooting skills, either basic or advanced, depending on the situation

Computerliteracy

Strong interpersonal skills

Effective oral communication skills

Professional conduct and accountability

Ability to problem solve and work with others under pressure

Ability to contribute and coordinate work in a team

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