Panorama Pediatric Group – Medical Biller/Coder

Pay: $18.50 - $27.50 per hour

Job description:

Medical Biller & Coder

Location: Panorama Pediatric Group – 961 Panorama Trail S, Suite 1, Rochester NY 14625

This is an on-site position, not remote.

General Job Description:

We are seeking an experienced and detailed-oriented professional to join our team and provide revenue cycle management services, including medical coding and billing, payment posting, insurance verification, provider credentialing, and other administrative support services as needed. The ideal candidate will have a strong background in medical billing and coding, along with excellent organizational and communication skills.

Essential Functions/Responsibilities that may be applicable:

Coding/Auditing:

• Evaluates medical record documentation and encounter coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflect and support the outpatient visit, and to ensure that data complies with legal standards and guidelines
• Interprets medical information such as diseases or symptoms, and diagnostic descriptions and procedures for a given visit to accurately assign and sequence the correct ICD 10, CPT codes and HCPCS II
• Reviews Medicaid, Medicaid Managed Care, and Commercial reimbursement claims before submission for completeness and accuracy and to minimize claim denial
• Provides technical guidance to clinical providers and other departmental staff in identifying and resolving issues or errors, such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, or codes that do not conform to approved coding principles/guidelines
• Educates and advises staff on proper code selection, documentation, procedures and requirements
• Identifies training needs, prepares training materials, and conducts training for clinical providers and support staff to improve skills in the collection and coding of quality health data
• Measure and report trends in provider coding

Billing Process:

• Evaluate encounters for completeness and ability to be billed
• Submit third party claims to payers for processing
• Work denials and rejections from clearinghouse and payers
• Resubmit denied claims as necessary
• Patient contact to resolve billing problem
• Aggressively follow-up on collection of aged accounts receivable
• Interact with Case Management staff on insurance problems
• Compliance activities as directed

Payment Processing:

• Post third party remittances
• Post payments received on patient accounts in a timely manner
• Work denials and rejections from payers
• Reconcile industry-specific applications to general ledger and resolve differences in a timely manner
• Post and reconcile daily cash receipt received (daily edit) to the EMR ledger (day sheet)

Medical Records Management

• Organize, update, and maintain patient medical records in compliance with HIPAA standards
• Retrieve and release records for audits, continuity of care, and insurance requests
• Support providers with documentation review to ensure completeness and coding accuracy
• Assist in transitioning or maintaining electronic health records (EHR/EMR) systems

Credentialing & Provider Enrollment

• Prepare and submit credentialing and re-credentialing applications for physicians and mid-level providers
• Maintain an up-to-date database of provider credentials, licenses, certifications, and insurance enrollments
• Track credentialing status and ensure timely renewals to avoid disruptions in billing
• Communicate with payers, credentialing committees, and internal teams regarding application progress
• Assist with compliance audits related to credentialing and provider files

General Administrative Support

• Coordinate between clinical staff, billing departments, and external payers to streamline workflows
• Support audit preparation and ensure data accuracy across systems
• Maintain confidentiality and uphold all privacy and compliance standards

Miscellaneous:

• Provide support within the Finance dept. in the event of another staff member’s absence
• Ensure patient demographics and insurance information is accurately entered in the EMR system
• Requires the ability to relate to people of diverse backgrounds, cultures, races, sexual orientations and gender identities or expressions
• Responsible for maintaining confidentiality of all patients, proprietary and protected information
• Miscellaneous filing, copying, faxing, etc. as needed to support Finance staff
• Employees are accountable for meeting performance standards. They participate in compliance audits and quality improvement plans
• Other job duties as assigned by supervisor

Essential Competencies:

• Carry out these duties in a responsible, professional and ethical manner; upholding the mission and values of the Practice
• Participate in departmental and Practice-wide staff meetings and other training in-service as assigned
• Demonstrate awareness of Practice mission, organizational goals, values, policies and procedures; work effectively across departmental boundaries, represent the Practice in professional manner
• Requires the ability to relate to people of diverse backgrounds, cultures, races, sexual orientations and gender identities or expressions

Skills and Abilities:

• Knowledge of medical terminology, ICD 10-CM and CPT coding
• Knowledge of coding policies
• Knowledge of insurance industry
• Knowledge of office billing practices, policies and procedures
• Analytical and problem-solving skills
• Strong attention to detail, and the ability to examine documents for accuracy and completeness
• Ability to work independently and as part of a team
• Proficiency in Microsoft Office (Excel, Word) and exposure to EHR/EMR and billing software
• Skill of persistence is needed when necessary
• Skill in computer programs, spreadsheets and applications
• Ability to read, understand and follow oral and written instruction
• Ability to communicate effectively and work with others
• Knowledge of grammar, spelling, and punctuation
• Ability to manage multiple tasks, meet deadlines and resolve issues proactively

Education and Experience:

• Certified Medical Coder (CMC) or Certified Professional Coder (CPC) or equivalent required
• 3-5 years’ experience in a medical office setting preferred
• 2 years’ experience in a medical office setting required
• Experience with Medent strongly recommended and EMR preferred

Physical Requirements:

• Sedentary work, ability to sit for extended periods of time
• Manual dexterity for using an adding machine/calculator and computer keyboard
• Required to stand, sit, walk, use hands to finger, handle or feel; reach with hands and arms, talk and hear
• Occasionally, the employee must stoop, bend and lift or move up to 25 lbs
• Specific vision abilities required include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus
• Ability to read data on the computer monitor and written documents
• Extensive use of computer software, typing and concentration

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee discount
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Send resumes to Lisa Chinnici at LChinnici@panoramapeds.com

Lisa Chinnici CMC, CMCA-E/M, Notary

Business Manager

Panorama Pediatric Group

Ph: 585-381-4982

Fax: 585-381-1821