Clinic Billing and Coding Specialist - Full Time - Rural Health Clinic in Blountstown, Florida at Calhoun Liberty Hospital Association, Inc

The Clinic Billing and Coding Specialist is responsible for the accurate and timely coding, billing, and submission of claims for services provided by the Calhoun Liberty Hospital Rural Health Clinic. This position ensures that all encounters are properly coded, charges are accurately captured, claims are submitted in accordance with payer requirements, and outstanding accounts are monitored and resolved. This position works closely with clinic providers, clinic colleagues, and Revenue Cycle colleagues to support efficient operation, maximize reimbursement, maintain regulatory compliance, and provide excellent service to patients and external representatives.

- Perform daily coding of clinic encounters using applicable ICD10, CPT, and HCPCS coding within established timeframes to ensure timely claim submission
- Assign accurate diagnosis and procedure codes based on provider documentation and established guidelines, ensuring coding supports medical necessity and applicable payer-specific requirements
- Prepare, review, and submit claims daily to Medicare, Medicaid, commercial insurance carriers, and all other third-party payers, ensuring accuracy and completeness of claims before submission
- Identify missing, incomplete, or inconsistent documentation that may affect coding, billing, or reimbursement and communicate the issues to providers or other appropriate colleagues to ensure corrections are made.
- Review and investigate denials, rejections, or improperly processed claims and prepare and submit corrected claims, reconsiderations, and appeals within established payer
deadlines.
- Communicate with payer representatives to resolve issues.
- Perform routine checks on accounts receivable to ensure timely reimbursement
- Monitor unpaid claims and identify accounts requiring additional follow-up, ensuring contact is made with insurance carriers regarding status, delays, and discrepancies.
- Review remittance and EOBs to identify underpayments or other issues
- Conduct and document routine audits of coded and billed claims to ensure accuracy, completeness, and compliance to identify potential issues
- Assist with corrective action plans and follow-up reviews to ensure identified issues are resolved.
- Participate in internal and external audits and regulatory reviews as needed.
- Document and trend claims, denials, documentation issues, delays, discrepancies, etc.
- Prepare weekly and monthly reports to send to clinic and hospital leadership
- All other duties as assigned

- Bachelor’s degree preferred, Associates considered
- 1+ years of experience in Medical Billing in the Clinic setting
- 1+ years of experience in Medical Coding in the Clinic setting
- Possess at least one of the following: AAPC CPC®, CPB®, COC®, CFPC™, or equivalent
- Current BLS (AHA or ASHI) (Can be obtained within 90 days of hire)
- Experience with Rural Health Clinic billing and reimbursement preferred
- Experience with Medicare and Medicaid claims processing required
- Experience with claim denials, appeals, follow-ups, and accounts receivable management required
- Excellent communication, listening, and leadership skills
- Must be able to speak, read and write the English language