Summary:
The Biller/Coder will be a key member of the team responsible for providing accurate and efficient medical billing and coding services for the Iowa Veterans Home. This role involves reviewing medical records, assigning appropriate codes, preparing and submitting claims, and following up on outstanding payments. The Biller/Coder will collaborate closely with the client and internal teams to ensure compliance with all regulations and optimize revenue cycle management.
Responsibilities:
1. Coding & Billing:
- Review medical records and accurately assign ICD-10, CPT, and HCPCS codes for diagnoses, procedures, and supplies, ensuring compliance with government coding guidelines and long-term care requirements.
- Prepare and submit electronic and paper claims to Medicare, Medicaid, Tricare, VA, and other government payers, adhering to specific billing requirements and deadlines.
- Ensure claims are submitted accurately and on time, meeting all payer-specific requirements, including documentation and prior authorization for long-term care services.
2. Coordination of Benefits
- Manage and coordinate benefits for patients with multiple insurance plans, including Medicare, Medicaid, Tricare, and VA coverage, to maximize reimbursement and minimize patient out-of-pocket costs.
- Determine the correct billing order for primary, secondary, and tertiary payers based on patient eligibility and coverage details.
- Apply payer-specific rules and regulations for coordination of benefits to ensure compliance and maximize reimbursement.
3. Payment Posting & Reconciliation:
- Accurately post payments received from various payers.
- Reconcile Explanation of Benefits (EOBs) with submitted claims.
- Identify and resolve payment discrepancies in a timely manner.
4. Denial Management:
- Review and analyze denied claims.
- Prepare and submit appeals for denied claims.
- Follow up on outstanding denials and work to overturn them.
5. Reporting & Compliance:
- Maintain accurate records of all billing and coding activities.
- Generate reports on billing performance and key metrics.
- Stay current on coding updates, billing regulations, and compliance requirements.
Qualifications:
- High school diploma or equivalent.
- Certified Professional Coder (CPC) certification or equivalent.
- 2+ years of experience in medical billing and coding, with expertise in billing for government payers (e.g., Medicare, Medicaid, Tricare, VA) and experience in a long-term care setting.
- Strong knowledge of medical terminology, anatomy, and physiology, with an understanding of government-specific billing codes and modifiers relevant to long-term care services.
- Proficiency in medical billing software and EHR systems, with experience in government billing platforms and interfaces used in long-term care facilities.
- Excellent attention to detail and accuracy, with a commitment to maintaining compliance with government regulations and payer-specific guidelines.
Preferred Qualifications:
- Experience working with veteran care facilities or government agencies.
- Knowledge of PointClickCare or similar clinic management software.
- Experience with MedOffice V20 billing software.
You must be legally authorized to work in the US, no sponsorship available at this time.
We provide equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
