Certified Professional Coder
San Antonio, Tx
Patient Services /
Remote
Beckley Clinical is seeking a detail-oriented and experienced Certified Professional Coder (CPC) to join our team. This position is responsible for oversight of Andala’s billing infrastructure, revenue cycle operations, and provider credentialing processes. The role requires a high level of accountability and precision in the design, development, and configuration of the AthenaHealth EHR billing system to ensure accurate claims submission, optimal reimbursement, and up-to-date provider credentials with all payers and facilities.
The CPC will analyze revenue cycle trends, address issues, implement improvements to meet financial goals, and lead cross-functional teams in strategic initiatives. This role also serves as a resource for providers and staff regarding coding, billing, revenue optimization, and credentialing requirements. The ideal candidate will have in-depth knowledge of medical coding systems, payer processes, healthcare regulations, and provider enrollment best practices.
Medical Coding, Billing & Claims Management
- Assign accurate ICD-10, CPT, and HCPCS codes for diagnoses, procedures, and services
- Review clinical documentation to ensure coding accuracy and completeness
- Query providers for clarification when documentation is insufficient
- Stay current with coding guidelines, updates, and regulatory changes
- Ensure compliance with HIPAA, CMS, and other healthcare regulations
- Prepare and submit electronic claims to insurance carriers, Medicare, and Medicaid
- Review claims for accuracy before submission to minimize denials
- Follow up on pending claims and resolve claim rejections or denials
- Process prior authorizations and pre-certifications as required
- Handle patient billing inquiries and payment posting
Revenue Cycle Management
- Monitor accounts receivable and aging reports
- Work denied and rejected claims through resolution
- Appeal denied claims with appropriate documentation
- Coordinate with insurance companies to resolve payment issues
- Track and report on key performance metrics (collection rates, denial rates, etc.)
- Participate in internal and external audits as required
- Assist with month-end and year-end closing procedures
- Generate reports for management and providers
- Support other administrative tasks as assigned
Patient Account Management
- Post insurance and patient payments accurately
- Set up payment plans for patients when appropriate
- Handle billing disputes and coordinate with patient accounts team
- Maintain accurate patient demographic and insurance information
- Process refunds and adjustments as needed
Credentialing
- Manage the end-to-end credentialing process for all providers, including initial credentialing, re-credentialing, and enrollment with new payers
- Maintain up-to-date provider files and ensure timely submission of credentialing applications to insurance companies, Medicare, Medicaid, and other networks
- Track and monitor credentialing status, expirations, and upcoming renewals (licenses, DEA, board certifications, etc.)
- Ensure compliance with payer-specific requirements, state regulations, and accreditation standards
- Serve as the primary point of contact for all credentialing-related inquiries from internal staff, providers, and external entities
- Coordinate with payers to resolve enrollment issues, update provider demographics, and maintain active status for reimbursement
- Develop and maintain a centralized credentialing database, including all necessary documentation and audit trails
- Communicate credentialing timelines and requirements to providers and leadership to avoid disruptions in billing or patient care
- Collaborate with HR and compliance teams to integrate credentialing processes with onboarding and ongoing provider compliance requirements
Education & Certifications
- Bachelor’s degree preferred
- Completion of medical billing/coding program from accredited institution
- Required Certification: CPC (Certified Professional Coder) - AAPC REQUIRED
- Additional Preferred Certifications: CCS (Certified Coding Specialist) - AHIMA; CCA (Certified Coding Associate) - AHIMA; CCS-P, COC, or specialty certifications)
Experience
- Minimum 3+ years of medical billing and coding experience in healthcare setting
- Experience with outpatient/clinic billing preferred
- Familiarity with multiple insurance carriers and payer requirements
- Proficiency Athena requiredAdvanced knowledge of Excel and Google Suite
- Experience with clearinghouses and electronic claim submission
- Familiarity with practice management systems
- Thorough understanding of ICD-10, CPT, and HCPCS coding systems
- Knowledge of Medicare, Medicaid, and commercial insurance billing requirements
- Understanding of HIPAA regulations and patient privacy requirements
- Familiarity with healthcare compliance and audit procedures
- Experience with appeals and grievance processes
$45,000 - $65,000 a year
