The Medical Billing/Coder (Certified) generates and submits hospital claims to third party payers and government agencies. Responsible for billing related functions for Bayhealth claims, whether electronic or hardcopy; in compliance with established ANSI standards. Serve as departmental resource for coding questions/concerns. Research and resolve Correct Coding Initiative (CCI) and Medical Unlikely claim edits. Interact directly with clinical departments explaining coding and/or other concerns to facilitate claim error resolution. Identifies trends and education opportunities related to coding and communicates those to management. Provide recommendations to improve coding and/or documentation to facilitate more accurate coding.
Minimum Education and Experience
High School diploma or GED
Three years hospital billing or collection experience.
Four years hospital billing or collection experience
Experience with medical billing and claims editing systems.
Experience with McKesson STAR system. Experience with xClaim.
CPC Coding Certification
Special Knowledge, Skills, and/or Abilities
• Knowledge of medical billing and collections.
• Experience with UB04 & HCFA1500 claim forms.
· Strong background in medical terminology
· Ability to communicate effectively with others
· Must be proficient in reading, writing, and speaking English.