Medical Insurance Billing And Coding Jobs in Delaware

Position Title: Certified Coder/Medical Biller

Reports to: Revenue Cycle Manager

Primary Location: Georgetown – (incumbent may be transferred or asked to report to any of LRHC’s locations based on the needs of the organization)

Wage Classification: Non-Exempt

Job Summary: The Medical Coder/Biller is responsible for accurate coding, billing, payment posting, and follow-up of medical claims. This position plays a critical role in ensuring timely reimbursement, compliance with federal and state regulations, and adherence to FQHC-specific billing requirements, including sliding fee scale policies

Essential Responsibilities:

The following duties are not intended to serve as a comprehensive list of all duties performed by all associates in this position. The duties listed are intended to provide a representative summary of the major duties and responsibilities. The incumbent may be required to perform additional, position-specific duties as assigned by their manager and/or LRHC Leadership.

Coding & Claims Submission

• Review coding denials for incorrect/expired CPT, HCPCS, and ICD-10 codes in accordance with payer and FQHC guidelines
• Assist providers with correct coding by providing feedback and clarification on documentation and coding requirements
• Identify coding errors, trends, or opportunities for improvement and recommend corrective actions
• Notify the Revenue Cycle Manager of repeated or significant coding errors and participate in corrective action planning
• Prepare, review, and submit clean claims to commercial insurers, Medicaid, Medicare, and other third-party payors
• Ensure claims are submitted in a timely manner and in compliance with federal, state, and payer regulations
• Supports Coding audits

Payment Posting & Electronic Payments

• Ensure accurate posting of contractual adjustments, write-offs, and patient responsibility amounts
• Work in Clearing house to submit and correct claims.
• Balance posted payments against bank deposits and remittance reports
• Research and correct posting errors in a timely manner
• Coordinate refunds and credit balance resolution in accordance with organizational policies
• Post payments accurately from insurance payors and patients into the practice management system
• Download and process electronic remittance advice (ERA) and electronic funds transfers (EFT)
• Identify and resolve payment discrepancies, underpayments, and overpayments

Denials Management & Follow-Up

• Work assigned claim denials, rejections, and unpaid claims, including researching payer policies, eligibility issues, authorization requirements, and coding-related denials
• Review explanation of benefits (EOBs) and remittance advice to determine denial reasons and appropriate corrective actions
• Correct and resubmit denied or rejected claims in a timely manner to meet filing limits
• Prepare, submit, and track insurance appeals with required documentation and supporting medical records
• Communicate with insurance payors via phone, portals, and correspondence to resolve complex or aged denials
• Analyze denial trends, research root causes, and prepare corrections or appeals as needed
• Follow up with payors to ensure timely resolution and maximum reimbursement
• Work AR aging reports provided by the Revenue Cycle Manager

Sliding Fee Scale & Patient Accounts

• Apply sliding fee scale adjustments in accordance with FQHC policies and federal guidelines
• Ensure patient charges and adjustments are calculated accurately based on income eligibility
• Collaborate with front desk and eligibility staff to resolve patient account issues
• Support Audits on Sliding Fee Scale

Compliance & Reporting

• Maintain compliance with HRSA, CMS, and payer billing requirements
• Support internal and external audits by providing documentation and billing clarification
• Communicate billing issues, trends, and process improvement opportunities to the Revenue Cycle Manager

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or competency required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• Certified Professional Coder (CPC) certification
• High school diploma or GED required
• Minimum 10 years of medical Coding and Billing experience in an FQHC or community health center
• Minimum 7 years of experience working Clearing house systems
• Working knowledge of CPT, ICD-10, HCPCS, and payer reimbursement methodologies
• Experience in FQHC coding, medical billing, health information management, or related field
• Experience with Medicaid, Medicare (including PPS for FQHCs), and commercial insurance billing
• Experience with electronic health record (EHR) and practice management systems
• Familiarity with HRSA and FQHC compliance requirements

Education and/or Experience:

• High School Diploma or GED required.

Language Skills:

English proficiency

Skills and Competencies:

• Strong attention to detail and analytical skills
• Ability to manage multiple priorities and deadlines
• Excellent written and verbal communication skills
• Ability to work independently and as part of a revenue cycle team
• Proficiency in Microsoft Office, Teams, Coding and Billing software

Equipment Operated:

Wide range of office equipment. Computer use and proficiency required.

Mental/Physical Requirements:

• Sitting for long periods while using a computer
• Ability to focus for sustained periods with minimal supervision