Certified Coder/Medical Biller

Position Title: Certified Coder/Medical Biller Reports to: Revenue Cycle Manager Primary Location: Georgetown - (incumbent may be transferred or asked to report to any of LRHC's locations based on the needs of the organization) Wage Classification: Non-Exempt Job Summary: The Medical Coder/Biller is responsible for accurate coding, billing, payment posting, and follow-up of medical claims.

This position plays a critical role in ensuring timely reimbursement, compliance with federal and state regulations, and adherence to FQHC-specific billing requirements, including sliding fee scale policies Essential Responsibilities: The following duties are not intended to serve as a comprehensive list of all duties performed by all associates in this position.

The duties listed are intended to provide a representative summary of the major duties and responsibilities.

The incumbent may be required to perform additional, position-specific duties as assigned by their manager and/or LRHC Leadership.

Coding & Claims Submission * Review coding denials for incorrect/expired CPT, HCPCS, and ICD-10 codes in accordance with payer and FQHC guidelines * Assist providers with correct coding by providing feedback and clarification on documentation and coding requirements * Identify coding errors, trends, or opportunities for improvement and recommend corrective actions * Notify the Revenue Cycle Manager of repeated or significant coding errors and participate in corrective action planning * Prepare, review, and submit clean claims to commercial insurers, Medicaid, Medicare, and other third-party payors * Ensure claims are submitted in a timely manner and in compliance with federal, state, and payer regulations * Supports Coding audits Payment Posting & Electronic Payments * Ensure accurate posting of contractual adjustments, write-offs, and patient responsibility amounts * Work in Clearing house to submit and correct claims.

* Balance posted payments against bank deposits and remittance reports * Research and correct posting errors in a timely manner * Coordinate refunds and credit balance resolution in accordance with organizational policies * Post payments accurately from insurance payors and patients into the practice management system * Download and process electronic remittance advice (ERA) and electronic funds transfers (EFT) * Identify and resolve payment discrepancies, underpayments, and overpayments Denials Management & Follow-Up * Work assigned claim denials, rejections, and unpaid claims, including researching payer policies, eligibility issues, authorization requirements, and coding-related denials * Review explanation of benefits (EOBs) and remittance advice to determine denial reasons and appropriate corrective actions * Correct and resubmit denied or rejected claims in a timely manner to meet filing limits * Prepare, submit, and track insurance appeals with required documentation and supporting medical records * Communicate with insurance payors via phone, portals, and correspondence to resolve complex or aged denials * Analyze denial trends, research root causes, and prepare corrections or appeals as needed * Follow up with payors to ensure timely resolution and maximum reimbursement * Work AR aging reports provided by the Revenue Cycle Manager Sliding Fee Scale & Patient Accounts * Apply sliding fee scale adjustments in accordance with FQHC policies and federal guidelines * Ensure patient charges and adjustments are calculated accurately based on income eligibility * Collaborate with front desk and eligibility staff to resolve patient account issues * Support Audits on Sliding Fee Scale Compliance & Reporting * Maintain compliance with HRSA, CMS, and payer billing requirements * Support internal and external audits by providing documentation and billing clarification * Communicate billing issues, trends, and process improvement opportunities to the Revenue Cycle Manager Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.

The requirements listed below are representative of the knowledge, skill, and/or competency required.

Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

* Certified Professional Coder (CPC) certification * High school diploma or GED required * Minimum 10 years of medical Coding and Billing experience in an FQHC or community health center * Minimum 7 years of experience working Clearing house systems * Working knowledge of CPT, ICD-10, HCPCS, and payer reimbursement methodologies * Experience in FQHC coding, medical billing, health information management, or related field * Experience with Medicaid, Medicare (including PPS for FQHCs), and commercial insurance billing * Experience with electronic health record (EHR) and practice management systems * Familiarity with HRSA and FQHC compliance requirements Education and/or Experience: * High School Diploma or GED required.

Language Skills: English proficiency Skills and Competencies: * Strong attention to detail and analytical skills * Ability to manage multiple priorities and deadlines * Excellent written and verbal communication skills * Ability to work independently and as part of a revenue cycle team * Proficiency in Microsoft Office, Teams, Coding and Billing software Equipment Operated: Wide range of office equipment.

Computer use and proficiency required.

Mental/Physical Requirements: * Sitting for long periods while using a computer * Ability to focus for sustained periods with minimal supervision