Type: Full-time


  • Administrative

Administrative Site:

Post Date: October 17, 2018

Close Date: October 25, 2018


The Billing/Coding Specialist performs a variety of functions in the revenue cycle, including, but not limited to, the items listed below:

Duties and Responsibilities

  1. Follow up on open balances due from insurances and other third party payors that are over 3 weeks old.
  2. Review charges posted by providers for medical, behavioral health, and dental claims.
  3. Attend to and answer patient questions regarding balances due such as deductibles, co-insurance, and copayments due from the patient.
  4. Manage and follow up on payment plans offered to patients with outstanding balances.
  5. Process, follow up on, and resolve requests for medical records and itemized billings.
  6. Document in each account any changes in claim status.
  7. Identify claims that need referrals or additional information for payment.
  8. Manually post payments from online lockbox, and reconcile payments posted against the amount in the lockbox. Flag and follow up on claim denials.
  9. Review and reconcile payments that are downloaded from clearinghouse.
  10. Review and analyze patient account credits and debits and initiate refund request for monies owed.
  11. Review and analyze account balances when insurances are requesting a refund.
  12. Follow up on all patient accounts where claim was denied for “patient not eligible at time of service”.
  13. Follow up with patients when updated insurance information is needed to process claim.
  14. Maintain regular communications with patients until such time that the accounts are paid in full.
  15. Attend all meetings of the department and other PrimeCare all-staff meetings.
  16. Coordinate and submit settlement offers for approval.
  17. Other duties, as assigned.

Required Skills or Abilities

  1. Work effectively with a diverse set of professionals and with multiple disciplines.
  2. Exercise independent judgment and prioritize effectively.
  3. Analyze, recommend, and implement creative improvements.
  4. Demonstrated ability to work in a team-based environment.
  5. Strong interpersonal skills, including the ability to establish strong working relationships and to communicate effectively and in a confidential manner.
  6. Maintain appropriate professional boundaries with all staff, trainees, and patients at all times.
  7. Demonstrate respect and sensitivity for cultural diversity, gender differences, and sexual orientation of patients and co-workers.
  8. Knowledge of ICD-10 and CPT-4 coding as well as basic medical terminology.
  9. Familiarity with EOBs (explanation of benefits).
  10. Proficient skills/experience with Microsoft Office products (Outlook, Word, Excel, PowerPoint) and Adobe.

Required Knowledge, Experience, or Licensure/Registration

  1. High school diploma required. Completion of certified coding program strongly preferred.  Bachelor’s degree in business administration, accounting, or finance preferred.
  2. 3 – 5 years of experience in outpatient/inpatient clinics, Medicaid, Medicare, and commercial insurances and experience in commercial insurance and Medicare/Medicaid follow ups.
  3. Prior experience in health care organizations and experience with federally qualified health centers strongly preferred.
  4. Prior experience with Athena strongly beneficial.
  5. Bilingual in English/Spanish or English/Polish.

Benefits include PTO, Health/Dental/Vision Insurance, Short-term and Long-term Disability Coverage, Life/AD&D, 403(b), paid holidays.