Staff members from Prism health North Texas Oak Cliff Health Center Clinic

Certified Coding Specialist Job – Dallas, TX

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Why You'll Love This Job

General Description:
This position is responsible for collecting payments from third-party medical, dental, and behavioral health payors. Collections activities include denial research, preparing & submitting appeals, and following up on unpaid, partial paid, or incorrectly paid claims. This includes identifying consistent payer-related payment delays, systematic denials, and communicating patterns to management. Collections Specialists will also support registration and insurance changes.

Responsibilities

Job Responsibilities
Specific Responsibilities of the Job:
  • Monitor claims status for prompt and accurate payment.  Follow up on, correct, and/or re-submit rejected, denied, partially paid, and incorrectly paid medical, dental, and behavioral health claims to insurance carriers in a timely manner.  Ensure proper documentation is attached to corrected claims, if needed.
  • Respond to payor correspondence; secure and submit additional documentation required or requested by insurance carriers.
  • Identify coding, billing, and/or payment errors from EOB/ERA and make indicated corrections. 
  • Identify consistent payer delays, systematic denials, and other patterns and communicate them to management.
  • Demonstrate and apply thorough understanding of insurance plan, Medicare, and Medicaid contracted rates, terms, and regulations to identify inaccurate payments and/or adjustments. 
  • Investigate, analyze, and resolve denials from insurance carriers. 
  • Understand and Analyze EOB/ERA information, including co-pay, deductible, co-insurance, coordination of benefits, contractual adjustments, denials, etc. to verify accuracy of insurance payments and patient balances
  • Post charges, payments, adjustments, etc., as assigned.
  • Maintain current knowledge on insurance carrier billing requirements and changes
  • Accurately and timely update insurance, payment, and claim activity information in EHR/billing system.  Demonstrate thorough understanding and effective, accurate use of the EHR/billing system.
  • Collaborate effectively with patients, providers, and staff as needed to obtain needed information and to continually improve organizational billing and collections performance. 
  • Other duties as assigned.

Skills & Qualifications

Required Knowledge, Skills and Abilities:
  • Detail-oriented, independent critical thinking and problem solving skills.
  • Demonstrated ability to handle multiple responsibilities and meet tight deadlines in a complex environment.
  • Demonstrated knowledge of medical, dental, and/or behavioral health provider reimbursement, medical terminology, ICD-10, CPT, and HCPCS coding.
  • Proficiency in MS Word, Excel, and Outlook. Experience with MS Teams preferred.
  • Excellent written and oral communication skills.
  • Excellent technical and business acumen.

Education and Experience:
  • High school or equivalent education required.  Associate's degree, Medical Assistant training, or other relevant certificates, certifications, or post-secondary education preferred.
  • Minimum of 3 years’ experience in medical collections (medical, dental, and/or behavioral health); billing; coding; and/or denials management required.
  • Medical and/or Dental Coding Certification required.
Preferred Qualifications:
  • Experience with Athena Centricity, athenaOne, or other Athena products preferred
  • Billing/coding/collections experience in a primary care or multi-specialty ambulatory setting preferred
  • Work experience in a Federally Qualified Health Center (FQHC) or FQHC look-alike a plus.
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