MEDICAL DENTAL CODER

Su Clinica Familiar; Harlingen (TX); On-site; USD 42,000 - 58,000; Full time

Job summary

Su Clinica Familiar is seeking a Billing and Coding Specialist to manage clinical charges, payments, and collections. You will process claims via AthenaOne EMR, handle denials, and ensure accurate coding (ICD-10/CPT) and timely billing in a patient-centered clinic.

The role requires knowledge of PCMH principles, strong customer service, bilingual English/Spanish abilities, and the ability to work in a fast-paced healthcare environment. This on-site position is located in Harlingen, TX."

Qualifications

• High school diploma or GED with billing and coding certification.
• 1+ year billing experience in Adults, Pediatrics or Women’s Health Services.
• Fluent in English and Spanish.
• Ability to work in a fast-paced environment.

Responsibilities

• Communicate with outside offices and insurance representatives by phone or secure email to resolve billing issues.
• Bill and code patient records with CPT/HCPCS and ICD-10 per program policies.
• Enter charges and payments accurately into the EMR system and reconcile accounts.
• Follow up on denials, appeals, and rejections and meet deadlines.
• Maintain documentation accurately and ensure HIPAA-compliant handling of records.

Skills

PCMH Model

Billing & Coding

ICD-10 coding

Microsoft Office

Customer relations

Bilingual EN/ES

Fast-paced environment

Education

High school diploma or GED

Billing and Coding certification

Tools

AthenaOne EMR

Job description

Job Location

HARLINGEN ANNEX - Harlingen, TX 78550

General Description

This position is vital in the health care delivery system in function with the fiscal aspect of the Clinic. The primary responsibility is to adhere to policies and procedures in conducting all clinical charges, processing payments and adjustments for proper billing and collections. The candidate will bill and submit claims to insurance programs through AthenaOne EMR, follow up on claim statuses, resolve claim denials, submit appeals, post payments and adjustments, and manage collections. Excellent customer service, telephone etiquette, computer proficiency, professional appearance, attention to detail, multitasking ability and the capacity to work in a fast‑paced environment are essential. The role functions as a member of a collaborative health‑care team to create and maintain a patient‑centered medical home.

Essential Job Functions

Communication: Communicates with outside provider offices and insurance representatives by telephone in a pleasant, culturally and linguistically appropriate manner or by secure email. Assures all questions are answered or resolved in a positive and cordial manner regarding billing issues and/or collection of fees for timely billing. Communicates unresolved issues to the supervisor or designee as needed.

Primary Billing Functions: Reviews and analyzes patient’s medical records for accuracy in diagnosis and CPTs, HCPCS codes for billing. Bills and codes as per policies and procedures of each program/grant and/or insurance. Accurately enters daily office and/or hospital charges into the database using medical coding protocol to produce a statement or claim for payment. Reviews medical records and efficiently addresses any discrepancies in coding with the medical provider. Verifies insurances when needed. Performs root cause analysis and identifies trends timely to minimize lag delays and maximize opportunities to improve processes. Enters payments received on accounts, applies payment to existing charges and ensures account balances are current and correct, including third‑party payers. Maintains productivity measures at all times to ensure deadlines are met and all revenue is captured. Trains or gathers information for proper billing at different clinics as needed.

Secondary Collections Functions: Submits claims daily to carriers via electronic batches, reconciles batches per system protocols. Resolves rejections and denials and ensures billing deadlines are not missed. Identifies and documents new payer denial trends and notifies supervisor. Follows up and thoroughly researches reasons for denied/rejected claims and works appeals as necessary to resolve outstanding balances. Ensures appeal deadlines are met. Downloads electronic statements and reviews EOBs and corrects errors promptly. Posts insurance payments accurately against patient accounts and reconciles charges daily. Handles all correspondence, including zero payments, denials and other information received from insurance carriers daily. Assists in providing copies of medical records including billing records in a HIPAA‑compliant manner. Receives calls from outside offices and assists questions regarding payments, EOBs and reasons for denials as requested by patients at the office.

Team Communication: Works closely with physicians and other departments to resolve issues with insurance companies regarding incorrect registration information, claims processing, coding issues and AR payments or denials. Educates staff on insurance policies to minimize denials/rejections as needed.

Management of Documentation: Assures all billing and collection documentation is accurate and current. Documents all adjustments and refunds as needed. Captures all documentation required for clinic programs accurately.

Safe Professional Conduct: Submits required documentation (credentialing, license renewals, certifications, CNE attendance, etc.) timely. Maintains professional appearance in dress and behavior. Maintains a friendly environment for self and others. Refrains from texting or speaking on cell phone during work hours. Participates in performance improvement and follows all clinic policies and procedures. Attends work on a regular and predictable schedule per clinic leave policy.

Qualifications

• Knowledge of PCMH Model
• Knowledge of SC policies and procedures
• Knowledge of medical billing practices
• Knowledge of ICD-10 and CPT coding
• Knowledge of computer software (Microsoft Word, Excel, Outlook, etc.)
• Skilled in customer relations
• Skilled in the use of a computer
• Skilled in billing and coding
• Ability to provide effective customer service on a daily basis
• Ability to read, write and spell correctly
• Ability to maintain an effective and professional working relationship with the public and co‑workers
• Ability to bend, stretch, stoop, stand, sit and lift up to 20 lbs
• Ability to operate a keyboard, telephone and other office equipment
• Ability to prepare records in accordance with detailed instructions
• Ability to communicate fluently in English and Spanish
• Ability to maintain a positive work environment
• Ability to work in a fast‑paced environment
• Ability to maintain a flexible work schedule
• Ability to maintain client and office confidentiality
• Ability to fully comply with the enhanced infection control requirements of the clinic

Minimum Qualifications

High school diploma or GED and certification in Billing and Coding from an accredited program, with one year or more of billing experience in Adults, Pediatrics or Women’s Health Services.

Special Instructions

Requires handling cash, collections, payments, billing, purchasing or inventory duties. Requires reserving no fewer than five consecutive days of accrued annual leave per year for this purpose. Requires travel; employee must provide transportation and possess a valid Texas driver’s license and liability insurance. May be necessary to work extended hours or other variations of a usual shift to ensure adequate care for patients and meet third‑party department needs.