Biller/Coder

Position Title: Biller/Coder

Department: Revenue Cycle/Billing

Position Reports to: Revenue Cycle & Billing Manager

Type: Full Time/Non-Union

Location: Marengo

Position Summary: The Biller/Coder is responsible for ensuring efficient and accurate loading of patient registration information into the OCHIN Epic system prior to the patient's scheduled appointment. This role requires meticulous attention to detail and strong organizational skills. It is preferred that the candidate maintains a strong understanding of California FQHC billing requirements and is proficient in OCHIN Epic Prelude and Resolute modules. The specialist will work closely with operations, billing, EHR Support Analysts, and other administrative professionals to streamline workflow and enhance patient care delivery.

Responsibilities:

• Analyze medical records and ensure all appropriate International Classification of Disease (ICD-9 & 10) and /or current Procedural Terminology (CPT) coding for billing of proper patient programs.
• Enter and retrieve patient medical data from EPIC-Ochin System updating entries as necessary; audit medical record for accuracy and completeness, note deficiencies and refer for appropriate follow up and completion.
• Consult with physicians and other personnel on coding practices and conventions to provide detailed coding information or gather additional documentation; maintain comprehensive records of all communications regarding suggested changes.
• Research and initiate activity to resolve charges and coding issues, review difficult situations to determine the most appropriate codes.
• Recognize potential for additional coding revenue and initiate the change in the EPIC-Ochin System.
• Enter charges as recorded by back office or clinicians with in a timely manner; charges should be posted with 48 hours of patient visit.
• Post payments to patient's accounts within a timely period, review all denials and resubmit to correct payer.
• All denials need to be investigated and follow up notes entered into the MIS System of any changes.
• Review and track payments of all submitted billing, reconcile visits and payers records on a weekly basis.
• Assist patients on program eligibility and on billing information.
• Handles special projects and other duties as requested.

• • Review the Department Appointment Report for Front-Loading, noting what needs to be updated for the patient's upcoming appointment.
  • Accurately review and/or update patient demographic information.
  • Verify assigned Guarantor.
  • Verify Coverage/Subscriber for accuracy.
  • Verify RTE, make corrections if necessary.
  • Review Federal Poverty Level for completion.
  • Ensure all patient data is up-to-date and correctly formatted in accordance with organizational standards.
  • Contact the patient to complete the registration workflow.
  • Ask the patient to verify or provide demographics and patient-level information.
  • Ask the patient to verify or provide Guarantor information.
  • Verify or complete the FPL with the patient; advising of patient needed items.
  • Ask the patient to provide or verify insurance information.
  • Advice the patient on documents required at check-in.
  • Inform patients of co-pay or out-of-pocket costs.
  • Collect for previous balances.

• • Create a patient message detailing items needing correction at the time of check-in.
  • Collaborate with clinical and administrative staff to gather necessary patient information and update records as needed.
  • Communicate effectively with team members to resolve any data discrepancies or issues promptly

• • • Communicate with front office Manager/supervisor for errors in registration
    • Regularly audit entered data to ensure accuracy and completeness.
    • Identify and correct any errors or inconsistencies in the patient records.

• • • • Provide front-line support for Epic-related issues, escalating complex problems to Billing supervisor.

• • Assist in training new staff on the proper use of the OCHIN Epic system and front-loading procedures.

• • Maintain accurate records of data entry activities and patient information updates.
  • Generate regular reports on front-loading performance and identify areas for improvement.

• Highs School graduate or equivalent.
• Associate Degree or two years of HIT college level coursework preferred.
• Knowledge of Medical Terminology and Anatomy & Physiology required.
• Knowledge of Title 22 medical record regulations preferred.
• Knowledge of Confidentiality and rules regarding HIPAA and State and Federal governing release of medical information required.
• Minimum two (2) years of continuous, relevant ICD/CPT coding experience in an acute care facility within the last five (5) years is required.
• System oriented experience in use of computerized medical records abstracting, encoding and database systems.

• Observe regulations on time card use and reporting.
• Maintain attendance as a policy.
• Maintain a clean and safe work area.
• Observe general Safety/Employee Health policies and procedures.
• Maintain a current annual health screening.
• Observe CMOAR Appearance/Dress standards.
• Maintain the privacy and confidentiality of both client and employee with regard to medical records.
• Display clearly visible identification.
• Treat all patients with respect and dignity and adheres' to the Patient Bill of Rights.
• Treats all employees with respect and dignity in accordance to non-discriminatory policy and procedure.
• Treat all employees/clients in a courteous and professional manner.
• Conduct only work related conversations when clients are waiting for service.
• Do not discuss other staff members, policies, problems or medical care in public areas of clinic.