Claims Compliance Specialty Coder

Billings Clinic•Billings, MT

About The Position

The Claims Compliance Specialty Coder researches and analyzes coding-related pre-bill scrubber edits, denials, and requests for review from Patient Financial Services. The role ensures accurate coding in compliance with government and third-party payer regulations and CPT-4, ICD, and HCPCS guidelines. The coder appeals denials and follows up with payers until claims are paid, revises and recodes claims as appropriate to maximize reimbursement, and collaborates with departments on audits and appeals. The position also identifies coding and compliance trends, provides findings and reports to Coding Resources Advisors and management, and delivers education to Coding Resources team members and other appropriate staff. The role follows Billings Clinic and regulatory policies governing medical-record coding, insurance billing, and reimbursement. This is a full-time, non-exempt position in Coding Resources at Billings Clinic Clinic. The listed schedule is day shift, 80 hours every two weeks. Starting wage is $23.92–$29.90, depending on experience.

Requirements

High school graduate or equivalent.
At least two years of experience in a multi-specialty clinic and/or hospital working with ICD-CM, CPT-4/HCPCS coding, billing, fees, and reimbursement.
Demonstrated ability to understand and develop information using databases and create complex spreadsheets.
Intermediate knowledge of Microsoft Office products, including Word, Excel, and PowerPoint.
At hire, hold a credential as RHIT, RHIA, CPC, CCS, or another AHIMA- or AAPC-recognized coding credential; alternatively, an equivalent combination of education and experience relating to the listed tasks, knowledge, skills, and abilities may be considered.
Any required license or certification must be properly held and in good standing.

Responsibilities

Research, analyze, and appeal government and third-party payer coding-related denials using explanation of benefits and remittance advice information and/or patient requests; follow up with payers until claims are paid.
Escalate high-complexity issues to Coding Resources Advisors, revise and recode claims when appropriate, provide supporting medical-record documentation and coding information, and report outcomes to management and advisors.
Follow applicable Billings Clinic and regulatory policies and procedures for medical-record coding, insurance billing, and reimbursement; seek current coding guidance and clarification as needed.
Identify coding trends or patterns that may pose compliance or reimbursement risks and report them to Coding Resources Management and Coding Resources Advisors for education, trending, and monitoring.
Research, analyze, and resolve government- and third-party-payer coding-related pre-bill scrubber edits.
Work with Patient Financial Services and management to improve claim edits in billing systems, process claims daily, and maintain daily goals and quality.
Identify and report regulatory or compliance concerns to the Coding Resources Manager and monitor coding-related audit activity in the organization’s tracking tool.
Work with the Clinical Coding Specialist and Coding Advisors to review external coding-audit determinations; assess medical records and extract documentation to support appeals.
Report issues to department managers and the compliance team, provide clinical documentation education to appropriate staff and physicians, and communicate with outside agencies when necessary to clarify issues.
Provide education to Coding Resources team members based on audit, edit, and denial research findings.
Support and model behaviors consistent with Billings Clinic’s mission, vision, values, code of business conduct, and service expectations; meet mandatory requirements and maintain relevant competencies.
Identify growth and development needs, meet applicable safety and departmental requirements, and perform other duties as assigned or needed.