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Overview: A Certified Professional Coder (CPC) job description generally involves reviewing patient medical records, abstracting relevant clinical information, and assigning appropriate medical codes using ICD-10, CPT, and HCPCS code sets. Psychological: Contact with Others, Deal with external customers/clients, sometimes dealing with unpleasant people, occasionally coordinating letters/memos, working with work groups or as a Team constantly/consistently.

Overview:
A Certified Professional Coder (CPC) job description generally involves reviewing patient medical records, abstracting relevant clinical information, and assigning appropriate medical codes using ICD-10, CPT, and HCPCS code sets. CPC responsibilities also include ensuring accurate documentation and coding, facilitating claims processing, and complying with regulatory requirements. 

Responsibilities:
<ol style="margin-top:0in"><li style="color:#001d35">Coding and Abstracting: Accurately translate patient encounters into standardized medical codes (ICD-10, CPT, and HCPCS). </li><li style="color:#001d35">Documentation Review: Analyze patient records for completeness, accuracy, and compliance with coding guidelines. </li><li style="color:#001d35">Reimbursement Analysis: Research and analyze data needs for accurate and timely reimbursement. </li><li style="color:#001d35">Auditing and Compliance: Conduct chart audits, identify coding discrepancies, and implement corrective actions. </li><li style="color:#001d35">Communication and Collaboration: Communicate effectively with healthcare providers to clarify coding issues and ensure accurate documentation. </li><li>Staying Updated: Keep abreast of changes in coding guidelines, regulations, and technology. </li></ol>

Qualifications:
<h1>Qualifications:</h1><ul style="margin-top:0in"><li>Education:</li></ul><ul><li style="margin-left:1in">Certified Professional Coder (CPC) or Certified Coding Specialist Physician Based (CCS-P) or Certified Radiology Coder (RCC) is required.</li></ul><ul style="margin-top:0in"><li>Experience:</li><li><ul style="margin-top:0in"><li>Prior experience doing physician/provider professional fee billing is preferred.   </li></ul></li><li>Skills and Abilities:</li><li><ul style="margin-top:0in"><li style="color:#001d35">Coding Knowledge: Strong understanding of coding systems (ICD-10, CPT, and HCPCS), coding guidelines, and relevant regulations. </li><li style="color:#001d35">Attention to Detail: Ability to meticulously review documentation and accurately assign codes. </li><li style="color:#001d35">Communication Skills: Effectively communicate with healthcare providers, billing staff, and other stakeholders. </li><li style="color:#001d35">Problem Solving: Ability to identify and resolve coding discrepancies and errors. </li><li style="color:#001d35">Organizational Skills: Maintain accurate records, manage workload effectively, and prioritize tasks. </li><li style="color:#001d35">Computer Skills: Proficiency in using coding software and electronic health records (EHR) systems. </li><li style="color:#001d35">Courier Route:  Must be able to use personal transportation to provide courier services for the office.</li></ul></li></ul> DCH Standards:<ul><li>Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.</li><li>Performs compliance requirements as outlined in the Employee Handbook</li><li>Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.</li></ul><ul style="margin-top:0in"><li>Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.</li><li>Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.</li><li>Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.</li></ul><ul><li>Requires use of electronic mail, time and attendance software, learning management software and intranet.</li><li>Must adhere to all DCH Health System policies and procedures.</li><li>All other duties as assigned.</li></ul> WORKING CONDITIONS Physical presence onsite is essential with possibility of hybrid work schedule.   Hearing and vision must be normal or corrected to within normal range.  Able to perform the duties with or without reasonable accommodation.Valid driver’s license and automobile liability insurance. Very good interpersonal communication and customer service skills required.    Physical:  Medium work – Exerting 20 – 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to more objects.  Physical Demand requirements are in excess of those for Light Work.   Good manual and finger dexterity.  Ability to tolerate prolonged periods of sitting.  Some light driving required.  Psychological:  Contact with Others, Deal with external customers/clients, sometimes dealing with unpleasant people, occasionally coordinating letters/memos, working with work groups or as a Team constantly/consistently.

DCH Health System

Certified Professional Coder

Analysis Skills

Auditing

Auto Insurance

Billing

Certified Coding Specialist (CCS)

Certified Professional Coder (CPC)

Claims Processing

Clinical Information

Communication Skills

Computer Skills

Corrective Action

Current Procedural Terminology (CPT)

Customer Support/Service

Data Analysis

Detail Oriented

Documentation

Documentation Review

Driver's License

Establish Priorities

Healthcare Common Procedure Coding System (HCPCS)

Healthcare Providers

ICD-10

Interpersonal Skills

Intranet Software/Application

Liability Insurance

Medical Billing

Medical Coding

Medical Record System

Medical Records

Needs Assessment

Organizational Skills

Performance Analysis

Performance Reviews

Problem Solving Skills

Psychology

Radiology

Record Keeping

Records Management

Regulations

Regulatory Compliance

Regulatory Requirements

Reimbursement

Safety/Work Safety

Team Player

Time Management

[AW]-iCims

This role is critical to optimizing revenue recovery by investigating, correcting, and resubmitting denied claims while working closely with the Revenue Cycle Management (RCM) team to identify and address patterns in denials. Psychological: Contact with Others, Deal with external customers/clients, sometimes dealing with unpleasant people, occasionally coordinating letters/memos, working with work groups or as a Team constantly/consistently.

Overview:
The Denials and Insurance Follow-Up Specialist is responsible for managing denied claims, following up with insurance payers, and ensuring accurate reimbursement for hospital services. This role is critical to optimizing revenue recovery by investigating, correcting, and resubmitting denied claims while working closely with the Revenue Cycle Management (RCM) team to identify and address patterns in denials. The ideal candidate will have strong analytical skills and experience in medical billing and insurance follow-up, with a focus on reducing accounts receivable days and improving cash flow.

Responsibilities:
<ol style="margin-top:0in"><li>Denial Management:</li><li><ol style="margin-top:0in"><li>Review and analyze denied claims to determine the cause of denial, coordinating with coding, billing, and clinical staff as needed to gather additional information or correct claim errors.</li><li>Prepare and submit appeal documentation for denied claims, following up with payers to ensure resolution within timely filing limits.</li><li>Track, document, and report denial reasons, resolution actions, and outcomes, identifying patterns and trends that require additional training or process improvements.</li></ol></li><li>Insurance Follow-Up:</li><li><ol style="margin-top:0in"><li>Conduct timely follow-up on unpaid claims with insurance companies, ensuring that all accounts are resolved or escalated within the hospital’s standard timeframes.</li><li>Verify insurance eligibility and benefits as needed to validate patient coverage and support claims correction or resubmission.</li><li>Communicate effectively with insurance representatives to resolve outstanding issues, confirm payment status, and clarify discrepancies in payments or coverage.</li></ol></li><li>Account Reconciliation and Resolution:</li><li><ol style="margin-top:0in"><li>Reconcile accounts to ensure payments align with expected reimbursement, identifying and addressing underpayments, overpayments, or unapplied funds.</li><li>Work closely with the RCM team to adjust accounts, apply payments accurately, and resolve balances on patient accounts after denial or underpayment resolution.</li></ol></li><li>Reporting and Analysis:</li><li><ol style="margin-top:0in"><li>Generate and analyze regular reports on denial rates, follow-up activities, and recovery outcomes to provide insights into common denial reasons and support improvement strategies.</li><li>Collaborate with management to develop and implement best practices for denial prevention, appeal success rates, and insurance follow-up efficiency.</li></ol></li></ol>

Qualifications:
<h1>Qualifications:</h1><ul style="margin-top:0in"><li>Education:</li></ul><ul><li style="margin-left:1in">High School Diploma or General Education Degree (GED) or 10 years’ experience in billing required. </li></ul><ul style="margin-top:0in"><li>Experience:</li><li><ul style="margin-top:0in"><li>Minimum six (6) years’ experience in medical billing, insurance follow up or denials management.</li><li>Prior experience do physician/provider professional fee billing is preferred.   </li><li>Familiarity with payer requirements, denial codes, and appeals processes for a range of insurance plans, including Medicare, Medicaid, and commercial payers.</li></ul></li><li>Skills and Abilities:</li><li><ul style="margin-top:0in"><li>Strong knowledge of healthcare claims processing, insurance reimbursement, and medical terminology.</li><li>Proficiency with electronic health record (EHR) and revenue cycle management (RCM) software.</li><li>Excellent analytical skills with the ability to identify root causes of denials and recommend corrective actions.</li><li>Detail-oriented with excellent organizational and time management skills, ensuring timely follow-up and adherence to deadlines.</li><li>Strong verbal and written communication skills, able to effectively interact with insurance</li><li>Strong communication and interpersonal skills to coordinate effectively with team members and external partners.</li><li>Able to analyze problems and strategize for better solutions</li><li>Ability to read and comprehend instructions, short correspondence and memos.  </li><li> Ability to effectively present information in one on one and small group meetings to clients and staff. </li><li>Able to Multi-tasking, prioritization, time management and critical thinking skills required. </li><li>Proficient computer skills, Microsoft Office Suites.  </li><li>Must be able to use personal transportation to provide courier services for the office. </li></ul></li></ul> DCH Standards:<ul><li>Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.</li><li>Performs compliance requirements as outlined in the Employee Handbook</li><li>Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.</li></ul><ul style="margin-top:0in"><li>Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.</li><li>Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.</li><li>Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.</li></ul><ul><li>Requires use of electronic mail, time and attendance software, learning management software and intranet.</li><li>Must adhere to all DCH Health System policies and procedures.</li><li>All other duties as assigned.</li></ul> WORKING CONDITIONS Physical presence onsite is essential with possibility of hybrid work schedule.  Hearing and vision must be normal or corrected to within normal range.  Able to perform the duties with or without reasonable accommodation.Valid driver’s license and automobile liability insurance. Very good interpersonal communication and customer service skills required.    Physical:  Medium work – Exerting 20 – 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to more objects.  Physical Demand requirements are in excess of those for Light Work.   Good manual and finger dexterity.  Ability to tolerate prolonged periods of sitting.  Some light driving required.  Psychological:  Contact with Others, Deal with external customers/clients, sometimes dealing with unpleasant people, occasionally coordinating letters/memos, working with work groups or as a Team constantly/consistently.

Denials Specialist III

Accounts Receivable

Best Practices

Cash Flow

Claims Management

Customer Relations

Denials Management

Health Insurance

Healthcare

Hospital

Insurance

Insurance Claims

Medicaid

Medical Terminology

Medicare

Microsoft Office

Multitasking

Patient Care Denials

Presentation/Verbal Skills

Reconciliation

Revenue Management

Root Cause Analysis

Strategic Analysis

Writing Skills

Responsibilities: Payment Posting: Accurately post payments and adjustments from various sources (insurance payments, patient payments, electronic remittances, manual check postings) to appropriate patient accounts. Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA): Efficiently manage EFT and ERA processes, identifying missing or misallocated payments and working with insurers or patients to resolve issues.

Overview:
The Payment Poster is responsible for ensuring accurate, timely posting of payments and adjustments for a range of medical services in our professional billing office. The role supports the Revenue Cycle by ensuring all patient and insurance payments are properly documented, accurately allocated, and balanced against patient accounts, optimizing revenue collection and reducing discrepancies.

Responsibilities:
<ol style="margin-top:0in"><li>Payment Posting: Accurately post payments and adjustments from various sources (insurance payments, patient payments, electronic remittances, manual check postings) to appropriate patient accounts.</li><li>Account Reconciliation: Reconcile daily, weekly, and monthly postings to ensure all payments align with patient records and financial reports. Investigate and resolve discrepancies promptly.</li><li>Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA): Efficiently manage EFT and ERA processes, identifying missing or misallocated payments and working with insurers or patients to resolve issues.</li><li>Denial and Adjustment Management: Work closely with the billing and claims teams to identify, research, and correct denied claims or underpayments. Adjust accounts as necessary following hospital policies and payer guidelines.</li><li>Communication with Stakeholders: Collaborate with internal teams (billing, coding, patient access) and external parties (payers, financial institutions) to ensure accurate and timely resolution of payment issues.</li><li>System Efficiency and Reporting: Utilize the hospital’s billing and EHR systems to track payments, generate reports on payment and adjustment activity, and provide insights on patterns affecting revenue.</li></ol>

Qualifications:
<h1>Qualifications:</h1><ul style="margin-top:0in"><li>Education:</li></ul><ul><li style="margin-left:1in">High School Diploma or General Education Degree (GED) or 3 years’ experience in healthcare setting required.</li></ul><ul style="margin-top:0in"><li>Experience:</li><li><ul style="margin-top:0in"><li>Minimum six (6) months clerical experience required.  </li><li>Prior experience do physician/provider professional fee billing is preferred.   </li><li>Ability to read and comprehend instructions, short correspondence and memos.  </li><li>Excellent written and verbal communication skills required. </li><li> Ability to effectively present information in one on one and small group meetings to clients and staff. </li><li>Able to Multi-tasking, prioritization, time management and critical thinking skills required. </li><li>Proficient computer skills, Microsoft Office Suites.  </li><li>Must be able to use personal transportation to provide courier services for the office. </li><li>Strong Customer Service skills and ability to answering both patient and insurance company questions.  </li><li>Able to analyze problems and strategize for better solutions</li></ul></li><li>Skills and Abilities:</li><li><ul style="margin-top:0in"><li>Proficiency in healthcare billing systems, EHR, and RCM software.</li><li>Strong attention to detail, with the ability to identify and resolve errors in payment postings and account reconciliations.</li><li>Good understanding of medical terminology, insurance claims processing, and denial management.</li><li>Ability to work independently and prioritize tasks in a fast-paced environment.</li><li>Strong communication and interpersonal skills to coordinate effectively with team members and external partners.</li><li>Excellent communication and interpersonal skills, with the ability to work collaboratively with multiple departments and external payers</li></ul></li></ul> DCH Standards:<ul><li>Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.</li><li>Performs compliance requirements as outlined in the Employee Handbook</li><li>Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.</li></ul><ul style="margin-top:0in"><li>Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.</li><li>Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.</li><li>Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.</li></ul><ul><li>Requires use of electronic mail, time and attendance software, learning management software and intranet.</li><li>Must adhere to all DCH Health System policies and procedures.</li><li>All other duties as assigned.</li></ul> WORKING CONDITIONS Physical presence onsite is essential with possibility of hybrid work schedule.  Hearing and vision must be normal or corrected to within normal range.  Able to perform the duties with or without reasonable accommodation.Valid driver’s license and automobile liability insurance. Very good interpersonal communication and customer service skills required.    Physical:  Medium work – Exerting 20 – 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to more objects.  Physical Demand requirements are in excess of those for Light Work.   Good manual and finger dexterity.  Ability to tolerate prolonged periods of sitting.  Some light driving required.  Psychological:  Contact with Others, Deal with external customers/clients, sometimes dealing with unpleasant people, occasionally coordinating letters/memos, working with work groups or as a Team constantly/consistently.

Posting Specialist I

Administrative Skills

Financial Reporting

High School Diploma

Patient Assessment

Payment Posting

Reporting Skills

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Certified Professional CoderDCH Health System

Denials Specialist IIIDCH Health System

Posting Specialist IDCH Health System

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