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Claims Edit Coder Jobs in Iowa (NOW HIRING)

Family Access Center

Behavioral Health Biller

Sioux City, IA · On-site

$18 - $23.25/hr

Audit & Edit: Review, troubleshoot, and correct rejected, denied, or unpaid insurance claims via ... Coding Compliance: Verify that clinicians have documented correct ICD-10 diagnostic codes and ...

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Claims Edit Coder information

What are the key skills and qualifications needed to thrive as a Claims Edit Coder, and why are they important?

To thrive as a Claims Edit Coder, you need a solid understanding of medical coding (ICD-10, CPT, HCPCS), claims processing, and healthcare regulations, typically supported by a coding certification such as CPC or CCS. Familiarity with electronic health record (EHR) systems, claims editing software, and payer-specific coding guidelines is crucial. Attention to detail, analytical thinking, and effective communication are vital soft skills for accurately identifying and resolving coding errors. These skills ensure correct claim submission, minimize denials, and support timely reimbursement for healthcare providers.

What are Claims Edit Coders?

Claims Edit Coders are healthcare professionals who review and analyze medical claims to ensure they are coded accurately and comply with insurance and regulatory guidelines. They use specialized coding systems, such as ICD-10, CPT, and HCPCS, to verify that procedures and diagnoses are properly documented. Their work helps prevent billing errors, reduce claim denials, and ensure timely reimbursement for healthcare providers. Claims Edit Coders often collaborate with billing departments and healthcare providers to resolve discrepancies and improve coding accuracy.

What is the difference between Claims Edit Coder vs Claims Processing Specialist?

AspectClaims Edit CoderClaims Processing Specialist
CertificationsCertified Coding Associate (CCA), CPCNone required, but certifications can be beneficial
Work EnvironmentHealthcare facilities, insurance companies, remoteInsurance companies, healthcare providers, office setting
Primary ResponsibilitiesReview and correct claim data, ensure coding accuracyProcess claims from submission to payment, handle inquiries

Claims Edit Coders focus on reviewing and correcting claim data to ensure accurate coding, while Claims Processing Specialists handle the overall processing of claims from submission to resolution. Both roles require knowledge of insurance policies and coding, but Claims Edit Coders are more specialized in coding accuracy, whereas Claims Processing Specialists manage broader claim workflows.

What are some common challenges faced by a Claims Edit Coder, and how can they be addressed?

Claims Edit Coders often encounter challenges such as staying updated with frequent changes in coding regulations and payer-specific requirements. Additionally, coding errors or discrepancies may arise due to incomplete or unclear documentation from providers. To address these issues, it's important to engage in ongoing education, actively communicate with clinical staff for clarification, and utilize reliable coding resources and software. Collaboration with team members and regular training can help maintain accuracy and compliance in claim submissions.
What are popular job titles related to Claims Edit Coder jobs in Iowa? For Claims Edit Coder jobs in Iowa, the most frequently searched job titles are:
What job categories do people searching Claims Edit Coder jobs in Iowa look for? The top searched job categories for Claims Edit Coder jobs in Iowa are:
Claims Edit Coder jobs near you

Behavioral Health Biller

Family Access Center

Sioux City, IA

$18 - $23.25/hr

Other

Medical, Life, Retirement, PTO

Posted 19 days ago

Job description

Behavioral Health Biller

Family Access Center is hiring a Behavioral Health Biller to join our team, supporting and empowering individuals to overcome life's challenges by providing quality services in our Sioux City office.

Key Responsibilities
  • Claim Scrubber & Correction (Primary Focus)
  • Audit & Edit: Review, troubleshoot, and correct rejected, denied, or unpaid insurance claims via the clearinghouse or insurance portals.
  • Appeals Management: Investigate the root causes of claim denials (e.g., prior authorization issues, coordination of benefits, coding errors) and submit formal appeals with necessary medical documentation.
  • Payment Posting & Reconciliation: Accurately post insurance payments (ERAs/EOBs) and patient payments to patient accounts, identifying any underpayments or processing errors.
Daily Billing Operations
  • Claim Submission: Prepare, review, and electronically submit daily clean claims for commercial insurance, Medicaid, Medicare, and managed care organizations (MCOs).
  • Coding Compliance: Verify that clinicians have documented correct ICD-10 diagnostic codes and mental health CPT codes (e.g., 90834, 90837, 90791) along with appropriate modifiers (e.g., 95 for telehealth).
  • Eligibility Verification: Confirm client insurance eligibility, mental health benefits, copays, deductibles, and track required prior authorizations.
Account & Client Management
  • Accounts Receivable (A/R) Tracking: Monitor the aging A/R report to actively follow up on outstanding claims over 30, 60, and 90 days old.
  • Patient Billing Support: Answer client inquiries regarding statements, deductibles, coverage discrepancies, and coordinate payment plans.
  • Provider Feedback: Communicate regularly with clinical staff to resolve missing documentation, signature requirements, or recurring coding errors.
Required Qualifications & Skills
  • Experience: 2+ years of dedicated medical billing experience, with a strict preference for mental/behavioral health billing.
  • Technical Savvy: Proficiency utilizing Electronic Health Record (EHR) systems and billing clearinghouses (e.g., SimplePractice, TherapyNotes, Kareo, Waystar, Availity).
  • Industry Knowledge: Strong familiarity with mental health CPT billing codes, modifiers, DSM-5/ICD-10 crosswalks, and timely filing limits.
  • Analytical Skills: High proficiency in reading and interpreting complex Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs).
  • Communication: Strong verbal and written communication skills for negotiating with insurance representatives and speaking empathetically with patients.
  • Certification (Preferred): Certified Medical Coder (CMC) or Certified Professional Biller (CPB) designation is a plus.
Benefits
  • Tuition Assistance
  • Paid Time Off
  • Holiday Pay
  • Health Insurance
  • Life Insurance
  • 401(k) plan
  • 401(k) matching
  • Referral Bonus

Job Types: Full-time

Salary: $22–28 per hour

Work Location: 1221 Pierce St., Sioux City, IA, 51105

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