Professional Coder/ Billing Specialist

Summary: The Professional Coder and Billing Specialist is responsible for reviewing clinical documentation, assigning accurate codes, and supporting compliant claim submission for medical, dental, and behavioral health services. This position ensures billing accuracy, supports reimbursement efforts, and remains current on coding updates, payer requirements, state laws, and regulatory changes.Under limited supervision, this position reviews clinical documentation and ensures that diagnosis and procedure codes are applied correctly during the billing process for medical, dental, and behavioral health services. Responsibilities include abstracting information from documentation, assigning appropriate codes, creating claims for payment by insurance carriers, submitting claims in accordance with governmental regulations and private payer policies, following up on claim status, resolving denials, submitting appeals, posting payments and adjustments, and supporting collections management. Major Responsibilities: • Reviews clinical documentation and assigns the most specific standard codes using CPT, ICD-10-CM, HCPCS Level II, and CDT.• Understands coding system guidelines, payer-specific code requirements, applicable government regulations, and compliance standards to ensure accurate coding.• Prepare, submit, and track claims for medical, dental, and behavioral health services in accordance with governmental regulations and payer policies.• Verify patient insurance eligibility, coverage, benefits, authorizations, and referrals as required.• Review accounts receivable aging reports and follow up on outstanding claims to promote timely reimbursement.• Research, analyze, and resolve denied, rejected, and underpaid claims.• Assist with patient billing questions, statements, balances, explanation of benefits, and payment arrangements.• Communicate with providers, staff, patients, and insurance representatives regarding billing and coding issues.• Audit claims, coding, and documentation for accuracy, compliance, and completeness.• Identify coding and billing discrepancies and recommend corrective action.• Support documentation improvement efforts and request clarification when documentation is incomplete or inconsistent.• Provides training, education, and support to providers and professional staff on coding and documentation requirements for medical, dental, and behavioral health services.• Utilizes the coding query process to obtain missing or unclear information and correct records containing discrepancies.• Stay current on coding changes, payer policies, billing requirements, regulatory updates, and compliance standards.• Assist with provider enrollment and other billing-related administrative functions as needed.• Participate in routine audits, performance improvement activities, coding compliance plans, research, analysis, benchmarking, and other assigned projects.• Conform to safety policies and general housekeeping practices.• Demonstrates professionalism, sound work ethics, flexibility, cultural awareness, and respect in all interactions with patients, staff and others.• Support Chugachmiut's mission and core values of respect, integrity, trust, compassion, and quality.• Be prepared to start shift on time, meet attendance standards, and work the hours necessary to perform the essential functions of the job.• Embrace, support, and promote the core values of respect, integrity, trust, compassion, and quality which align with Chugachmiut's Mission and Vision through their actions and interactions with all patients, staff, and others.• Serves and protects the company by adhering to professional standards, policies, and procedures, federal, state, and local requirements, and OSHA standards.• Conforms to Chugachmiut policies, strict employee confidentiality, HIPAA and 42 C.F.R. Part 2 regulations.• Performs other duties as assigned or required.Education Requirements: • Associate's Degree in Health Information Management preferred, or progressively responsible professional exempt level experience may be substituted. • Two (2) or more years of medical, dental, or behavioral health coding experience. An equivalent combination of relevant education and/or training may be substituted for experience• One of the following certifications: Certified Coding Specialist (CCS), Certified Coding Specialist-Physician (CCS-P), Certified Professional Coder (CPC), or an equivalent coding certification. Demonstrated experience in medical, dental or behavioral health billing/coding may be considered in lieu of certification. • Experience working in an Alaska Native Tribal Health billing environment is preferred.• Ongoing continuing education required to maintain certification and remain current on annual coding updates.Hours of Work: Work is performed during current business hours, with the potential to work extended hours during the week and/or weekend. Shifts of 7.5 hours or more per day will include a 1-hour unpaid lunch. Chugachmiut maintains a drug and alcohol and non-smoking work environment.