Coding/Billing Clerk

Ontario Trillium Foundation; New Roads (LA); On-site; USD 35,000 - 55,000; Full time

Job description

As a Coding/Billing Clerk, you will abstract clinical information from medical records and assign accurate ICD-10-CM, CPT, and HCPCS codes using industry-standard guidelines. You will also support billing and claims workflows by ensuring documentation is complete, charges are entered correctly, codes are sequenced according to regulatory and payer requirements, and claim issues are followed through to resolution. You will work within coding and billing databases, perform quality audits, and maintain up-to-date knowledge of coding and documentation requirements. This role reports to the Medical Records Coding Supervisor.

Job Specifications

Duties & Responsibilities (Department-Specific)

• Assign Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and ICD-10-CM (ICD-10 Clinical Modification) codes based on documentation.

• Assign Ambulatory Payment Classifications (APC) and/or Diagnosis-Related Group (DRG) codes as required.

• Select appropriate codes and functions for each case, including diagnoses, procedures, and complex classification scenarios.

• Abstract and code patient encounters accurately.

• Research and analyze coding and documentation needs to support reimbursement.

• Ensure codes are sequenced correctly according to government and insurance regulations.

• Verify that medical records are filed and processed correctly.

• Analyze medical records to identify documentation deficiencies and coding opportunities.

• Serve as a resource and subject matter expert to other coding staff.

• Review and verify documentation for diagnoses, procedures, and treatment outcomes.

• Identify diagnostic and procedural information necessary for coding.

• Process claims through the charge entry process for medical and dental clinics.

• Follow up on claim denials and other billing-related issues.

• Complete billing clean-up tasks, including working denials, verifying guarantor information, and following up on missing information as directed by the Reimbursement Coordinator.

• Maintain tracking logs for all claims worked for clean-up and follow-up actions.

• Review daily superbills to confirm charge posting, coding accuracy, primary diagnosis selection, and completeness of insurance and patient documentation.

• Record diagnoses on required forms used to complete clinic insurance documentation.

• Follow up on secondary payments on Medicare claims.

General Performance Standards

• Use clinic resources efficiently and effectively.

• Maintain discipline and follow accepted office standards.

• Work with minimal supervision by seeking guidance when issues arise beyond current knowledge or experience.

• Attend clinic and staff meetings, participate actively in problem-solving, and support in-service training.

• Communicate clearly and professionally with patients, visitors, and team members, while adhering to customer service standards.

• Maintain confidentiality of patient information and clinic business, and support the clinic mission and patient rights and responsibilities.

• Perform duties in accordance with all clinic policies and procedures.

• Participate in education opportunities that improve coding and billing effectiveness.

• Remain flexible to support cross-training and adjustments to the work schedule as needed, in alignment with clinic policy.

• Stay current with and follow all policies and procedures in the Policy & Procedure Manual.