Certified Medical Biller/Coder (DIRECT HIRE ONLY)

Certified Medical Biller/Coder & Revenue Cycle Manager

Focus Clinic is seeking a full-time Certified Medical Biller/Coder and Credentialing Specialist to take ownership of our revenue cycle operations as our clinic continues to grow. This role is ideal for a highly organized, proactive, and mission-driven professional with expertise in medical coding, insurance billing, and accounts receivable. The successful candidate will combine exceptional attention to detail and accountability with the compassion and clear communication our patients and families deserve.

Key Responsibilities:

• Medical Coding and Documentation Review
  • Accurately assign CPT, ICD-10-CM, HCPCS, and applicable modifier codes across Focus Clinic's multidisciplinary services, including medical visits, diagnostic evaluations and testing, therapy services, and other covered services.
  • Review clinical documentation to confirm that services are supported, appropriately coded, and compliant with payer requirements.
  • Identify incomplete, inconsistent, or insufficient documentation and communicate with providers to resolve issues before claims are submitted.
  • Stay current with coding updates, payer policies, bundling rules, and medical-necessity requirements that affect the clinic's services.
  • Conduct periodic coding reviews to identify recurring errors, reduce compliance risk, and improve clean-claim rates.
• Billing and Claims Management
  • Manage the complete claims lifecycle, including charge review, claim creation, submission, correction, resubmission, and follow-up through final resolution.
  • Utilize TriZetto to submit and track claims, address clearinghouse rejections, and maintain an efficient claims workflow.
  • Support billing operations within eClinicalWorks, including available AI-enabled revenue cycle management tools.
  • Monitor claim status and promptly address rejections, processing delays, requests for additional information, and timely-filing concerns.
  • Review payments and remittance information to identify incorrect adjustments, underpayments, or other payer discrepancies.
  • Maintain accurate notes and documentation of all payer communications and claim-related actions.
• Accounts Receivable, Denials, and Appeals
  • Monitor insurance and patient accounts receivable, prioritize aging balances, and work accounts consistently through resolution.
  • Investigate denied, rejected, or unpaid claims to identify the root cause and determine the appropriate corrective action.
  • Prepare and submit corrected claims, reconsideration requests, and formal appeals with the documentation necessary to support payment.
  • Follow up with payers through telephone calls, portals, and written correspondence until claims are appropriately resolved.
  • Identify recurring denial patterns and recommend changes to coding, documentation, registration, or front-office workflows.
  • Track key revenue cycle indicators, such as aging accounts, denial trends, clean-claim rates, and outstanding balances, and provide regular updates to clinic leadership.
• Patient Balances, Pre-Collection Support, and Financial Communication
  • Work patient and guarantor balances consistently, respectfully, and efficiently before accounts are considered for transfer to the clinic's external collection agency.
  • Contact families regarding outstanding balances, document collection efforts, and help resolve account questions or discrepancies.
  • Follow established clinic procedures for identifying truly delinquent accounts and preparing them for external collections.
  • Support the preparation and communication of patient estimates and help families understand anticipated out-of-pocket expenses.
  • Assist with resolving credit balances, refunds, payment posting concerns, and other patient-account issues as needed.
• Front-Desk Support and Up-Front Collections
  • Serve as the primary escalation resource when front-desk staff needs assistance determining estimated patient responsibility or managing complex financial situations.
  • Help staff interpret available eligibility and benefit information, including deductibles, copayments, coinsurance, and limitations that may affect patient responsibility.
  • Support accurate collection of required payments at or before the time of service.
• Revenue Cycle Improvement and Compliance
  • Take ownership of day-to-day revenue cycle performance and proactively identify opportunities to improve accuracy, efficiency, and cash flow.
  • Maintain organized records and ensure billing activities comply with applicable regulations, payer contracts, and clinic policies.
  • Collaborate with providers, clinical staff, front-desk team members, leadership, and outside vendors to resolve revenue cycle concerns.
  • Provide leadership with clear reporting on unresolved claims, aging balances, denial trends, workflow concerns, and recommended corrective actions.
  • Assist with payer audits, documentation requests, and internal compliance reviews as needed.
• Provider Credentialing and Enrollment (Optional, Based on Experience)
  • Lead provider credentialing, payer enrollment, and recredentialing activities across applicable portals and systems, including CAQH.
  • Complete and monitor new-provider enrollment applications, demographic updates, roster submissions, and payer maintenance requests.
  • Maintain accurate provider profiles, licenses, certifications, malpractice coverage information, and other required credentialing documents.
  • Track application deadlines and effective dates and follow up regularly with payers to prevent unnecessary enrollment delays.
  • Verify that providers remain active, properly affiliated, and billable with contracted health plans. Maintain an organized credentialing tracker and provide timely status updates to clinic leadership.
  • Troubleshoot enrollment-related claim denials and coordinate corrections with payers, providers, and clinic leadership.

Hours:

• Flexible hours averaging 10-20 hours/week

Qualifications:

• Required
  • Coding certification: AAPC Certified Professional Coder (CPC), AHIMA Certified Coding Specialist (CCS), or AHIMA Certified Coding Specialist - Physician-based (CCS-P).
  • Outpatient/clinic revenue cycle experience (billing, coding, A/R follow-up, and patient balances).
  • Strong understanding of EOBs, denials, payer rules, and patient responsibility (copays, coinsurance, deductibles).
  • Ability to communicate warmly and clearly with families about finances while holding firm to clinic policies.
  • High integrity and commitment to compliance, accuracy, and patient experience.
• Preferred
  • TriZetto experience (clearinghouse workflow proficiency).
  • Experience in eClinicalWorks (eCW).
  • Experience in pediatric behavioral health / testing-adjacent billing environments (or similarly complex outpatient services).
  • Process-improvement mindset (clean claim rate, denial reduction, A/R days improvement).
  • Credentialing experience (provider enrollment + re-credentialing) with demonstrated ability to manage timelines and payer requirements.

Why Join Focus Clinic?

• Own the revenue cycle, not just a task list: You will be a key driver of how we code, bill, credential, and communicate financial expectations.
• Make finances feel human: Many families reach out because they're overwhelmed and need clarity. You'll help them understand coverage, out-of-pocket costs, and payment options with warmth, professionalism, and confidence.
• Work in a mission-first, faith-based culture: We're serious about excellence, integrity, and compassionand we want our billing experience to reflect the same values as our clinical care.
• Collaborate with a multidisciplinary team: You will work closely with providers and the front desk to reduce denials, tighten workflows, and ensure the right amount is collected at the right time.
• Stability: This position will stay in-house without outsourcing.

About Focus Clinic:

Focus Clinic is dedicated to helping children with ADHD, learning differences, and behavioral challenges unlock their full potential. We combine medical, psychological, and educational expertise under one roof, offering services that include comprehensive diagnostic assessments, neurofeedback, cognitive therapy, nutritional support, coaching, medication management, and IEP/504 plan advocacy.

Our approach is comprehensive, individualized, and strengths-based, designed to support the whole child and uplift every family we serve.

Equal Opportunity Employer:

Focus Clinic is committed to creating a work environment that reflects the diversity