Medical Dental Coder

Job Location

HARLINGEN ANNEX - Harlingen, TX 78550

This position is vital in the health care delivery system in function with the fiscal aspect of the Clinic. The primary responsibility is to adhere to policies and procedures in conducting all clinical charges, processing payments and adjustments for proper billing and collections. The candidate will bill and submit claims to insurance programs through Athena One EMR, follow up on claim statuses, resolve claim denials, submit appeals, post payments and adjustments, and manage collections.

Excellent customer service, telephone etiquette, computer proficiency, professional appearance, attention to detail, multitasking ability and the capacity to work in a fast‑paced environment are essential. The role functions as a member of a collaborative health‑care team to create and maintain a patient‑centered medical home.

Communication: Communicates with outside provider offices and insurance representatives by telephone in a pleasant, culturally and linguistically appropriate manner or by secure email. Assures all questions are answered or resolved in a positive and cordial manner regarding billing issues and/or collection of fees for timely billing. Communicates unresolved issues to the supervisor or designee as needed.

Primary Billing Functions: Reviews and analyzes patient’s medical records for accuracy in diagnosis and CPTs, HCPCS codes for billing. Bills and codes as per policies and procedures of each program/grant and/or insurance. Accurately enters daily office and/or hospital charges into the database using medical coding protocol to produce a statement or claim for payment. Reviews medical records and efficiently addresses any discrepancies in coding with the medical provider.

Verifies insurances when needed. Performs root cause analysis and identifies trends timely to minimize lag delays and maximize opportunities to improve processes. Enters payments received on accounts, applies payment to existing charges and ensures account balances are current and correct, including third‑party payers. Maintains productivity measures at all times to ensure deadlines are met and all revenue is captured. Trains or gathers information for proper billing at different clinics as needed.

Secondary Collections Functions: Submits claims daily to carriers via electronic batches, reconciles batches per system protocols. Resolves rejections and denials and ensures billing deadlines are not missed. Identifies and documents new payer denial trends and notifies supervisor. Follows up and thoroughly researches reasons for denied/rejected claims and works appeals as necessary to resolve outstanding balances. Ensures appeal deadlines are met. Downloads electronic statements and reviews EOBs and corrects errors promptly.

Posts insurance payments accurately against patient accounts and reconciles charges daily. Handles all correspondence, including zero payments, denials and other information received from insurance carriers daily. Assists in providing copies of medical records including billing records in a HIPAA‑compliant manner. Receives calls from outside offices and assists questions regarding payments, EOBs and reasons for denials as requested by patients at the office.

Team Communication: Works closely with physicians and other departments to resolve issues with insurance companies regarding incorrect registration information, claims processing, coding issues and AR payments or denials. Educates staff on insurance policies to minimize denials/rejections as needed.

Management of Documentation: Assures all billing and collection documentation is accurate and current. Documents all adjustments and refunds as needed. Captures all documentation required for clinic programs accurately.

Safe Professional Conduct: Submits required documentation (credentialing, license renewals, certifications, CNE attendance, etc.) timely. Maintains professional appearance in dress and behavior. Maintains a friendly environment for self and others. Refrains from texting or speaking on cell phone during work hours. Participates in performance…