Claims Compliance Specialty Coder

Billings Clinic; Billings (MT); On-site; USD 33,000 - 41,000; Full time

Job summary

Billings Clinic is seeking a detail-oriented Coding Resources specialist to analyze pre-bill scrubber edits, denials, and review requests. You will ensure coding accuracy in line with CPT-4/HCPCS, ICD-10-CM guidelines, and payer regulations, while educating the team on findings and best practices.

The role involves collaborating with multiple departments, appealing denials, and supporting ongoing audits to maximize reimbursement and maintain compliance.

Qualifications

• High school graduate or equivalent.
• RHIT or RHIA certification, CPC or CCS, or AHIMA/AAPC equivalent.
• Experience with ICD-CM, CPT-4/HCPCS coding, billing, and reimbursement.

Responsibilities

• Researches and analyzes coding-related pre-bill scrubber edits, denials, and review requests.
• Ensure coding compliance with government and third-party payer regulations.
• Appeal denials and follow up with payers until paid.
• Provide education to Coding Resources teams based on audit findings.

Skills

RHIT/RHIA CPC/CCS

ICD-CM CPT-4 HCPCS

Denials appeals

Data analysis

Microsoft Excel

Team collaboration

Regulatory compliance

Education

High school diploma

RHIT or RHIA

CPC or CCS

Tools

Microsoft Word

Excel

PowerPoint

Job description

Billings Clinic Coding Resources

You'll want to join Billings Clinic for our outstanding quality of care, exciting environment, interesting cases from a vast geography, advanced technology and educational opportunities. We are in the top 1% of hospitals internationally for receiving Magnet Recognition consecutively since 2006.

And you'll want to stay at Billings Clinic for the amazing teamwork, caring atmosphere, and a culture that values kindness, safety and courage. This is an incredible place to learn and grow. Billings, Montana, is a friendly, college community in the Rocky Mountains with great schools and abundant family activities. Amazing outdoor recreation is just minutes from home. Four seasons of sunshine! You can make a difference here.

Billings Clinic is a community-owned, not-for-profit, physician-led health system based in Billings with more than 4,700 employees, including over 550 physicians and non-physician providers. Our integrated organization consists of a multi-specialty group practice and a 304-bed hospital. Learn more about Billings Clinic and how we are recognized nationally for our exceptional quality.

Your benefits include a comprehensive and competitive benefits package to all full- and part-time employees (minimum of 20 hours/week), including Medical, Dental, Vision, 403(b) Retirement Plan with employer matching, Defined Contribution Pension Plan, Paid Time Off, employee wellness program, and much more.

Billings Clinic is proud to be recognized for nursing excellence as a Magnet-designated organization, joining only 97 other organizations worldwide that have achieved this honor four times. The re-designation process happens every four years.

Shift: Day

Employment Status: Full-Time (.75 or greater)

Hours per Pay Period: 1.00 = 80 hours every two weeks (Non-Exempt)

Starting Wage DOE: $23.92 - $29.90

Responsible for researching and analyzing coding related pre-bill scrubber edits, denials, and requests for review from Patient Financial services, and ensuring proper coding in compliance with government and third party payer regulations and CPT-4, ICD, and HCPCs guidelines. Responsible to appeal denials and follow up with payers until the denied claims are paid. Collaborates with multiple departments and participates in review of Recovery Audit Contractor and other government audits and appeals. Provides reports to Coding Resources Advisors for trending and research and clarification of coding (ICD, CPT- 4/HCPCS) and abstracting of diseases and surgical procedures. Provides education to the Coding Resources teams based on findings.

Supports and models behaviors consistent with Billings Clinic's mission, vision, values, code of business conduct, and service expectations. Meets all mandatory organizational and departmental requirements. Maintains competency in all organizational, departmental, and outside agency standards as it relates to the environment, employee, patient safety, or job performance. Researches, analyzes, and appeals government and third-party payer coding-related denials of service based on explanation of benefits and remittance advice information and/or patient requests. Appeals denials and follow up with payers until the denied claims are paid. Escalates high complexity issues to the Coding Resources Advisors. Revises and recodes claims as appropriate to maximize reimbursement. Maintains a detailed knowledge of and ensures adherence to all applicable Billings Clinic and regulatory compliance policies/procedures governing medical record coding, insurance billing, and reimbursement methodologies in all aspects of the job. Actively seeks out clarification and/or updated information to ensure the most current guidelines are followed. Supplies appropriate documentation from the medical record and coding information from expert sources. Reports outcome to management and Coding Resources Advisors. Identifies trends/patterns that could pose a compliance risk or reimbursement issue and reports them to Coding Resources Management and Coding Resources Advisor for coding and documentation education, trending, and monitoring.

Researches, analyzes, and resolves government- and third-party-payer coding-related per-bill scrubber edits. Works closely with Patient Financial Services and management to improve claim edits in all billing systems in order to keep coding-related denials to a minimum. Works claims daily and maintains daily goals and quality. Identifies and reports any regulatory or compliance concerns to the Coding Resources Manager. Monitors coding-related audit activity in the organization's tracking tool. Works in conjunction with the Clinical Coding Specialist and Coding Advisors to review all coding-related external audit determinations. Apply clinical and coding assessment skills to medical records and extract supportive documentation for appeals. Report any issues to the department managers and the compliance team. Provide clinical documentation education to appropriate staff and physicians. Communicate with outside agencies when necessary to clarify issues. Provides education to the Coding Resources team members based on audit, edit, and denial research findings. Identifies needs and sets goals for own growth and development; meets all mandatory organizational and departmental requirements. Maintains competency in all organizational, departmental, and outside agency environmental, employee, or patient safety standards relevant to job performance. Performs other duties as assigned or needed to meet the needs of the department/organization.

Education: High school graduate or equivalent

Experience: Minimum 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.

Certifications and Licenses: Credential as Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA), Certified Professional Coder (CPC) or Certified Coding Specialist (CCS), or other AHIMA or AAPC recognized coding credentials at hire. Or an equivalent combination of education and experience relating to the above tasks, knowledge, skills and abilities will be considered. Employees that require a licensed or certification must be properly licensed/certified and the licensure/certification must be in good standing.

Billings Clinic is Montana's largest health system serving Montana, Wyoming and the western Dakotas. A not-for-profit organization led by a physician CEO, the health system is governed by a board of community members, nurses and physicians. Billings Clinic includes an integrated multi-specialty group practice, tertiary care hospital and trauma center, based in Billings, Montana. Learn more at www.billingsclinic.com/aboutus.

Billings Clinic is committed to being an inclusive and welcoming employer, that strives to be kind, safe, and courageous in all we do. As an equal opportunity employer, our policies and processes are designed to achieve fair and equitable treatment of all employees and job applicants. All employees and job applicants will be provided the same treatment in all aspects of the employment relationship, regardless of race, color, religion, sex, gender identity, sexual orientation, pregnancy, marital status, national origin, age, genetic information, military status, and/or disability. To ensure we provide an accessible candidate experience for prospective employees, please let us know if you need any accommodations during the recruitment process.