The Medical Billing and Coding Specialist is responsible for accurately processing, reviewing, and submitting medical claims for a large multi-specialty physician practice. The role ensures timely reimbursement by verifying coding accuracy, resolving claim edits, following up on outstanding balances, and supporting patients and providers with billing inquiries. The specialist collaborates closely with outsourced billing company employees, clinical departments, and payers to uphold revenue integrity and optimize financial performance.
Essential Duties
- Review and correct coding denials from outsourced billing company for resubmission to insurance carriers, government programs, and third-party payers per payer guidelines.
- Review charges for accuracy, completeness, and compliance with CPT, HCPCS, and ICD-10 coding standards.
- Resolve claim edits, denials, and rejections by correcting coding errors and/or assisting providers with coding corrections.
- Conduct timely follow-up on unpaid or underpaid claims to ensure optimal reimbursement.
- Process adjustments, refunds, and billing corrections as needed.
- Respond to patient billing inquiries professionally and with strong customer service.
- Monitor aging reports and maintain accounts receivable within departmental benchmarks.
- Collaborate with billing teams and clinical teams to clarify documentation or coding discrepancies.
- Maintain knowledge of payer policies, contract terms, and regulatory billing guidelines.
- Support month-end close processes and assist with revenue cycle projects as assigned.
- Perform other related duties as assigned.
Compliance and Professional Expectations
- Adhere to all federal, state, and local laws, regulations, standards, guidelines, and company policies and procedures.
- Maintain confidentiality and protect patient information in accordance with privacy laws and organizational policies.
- Maintain accurate documentation and records.
- Participate in all assigned training and complete it by required deadlines.
- Report compliance issues, unethical conduct, and incidents appropriately.
Requirements & Qualifications
Qualifications
- High school diploma or equivalent.
- Minimum 10 years of medical billing experience, preferably in a multi-specialty or large physician practice setting.
- Certification as a Certified Professional Coder (CPC) or a similar credential is required.
Skills and Knowledge
- Strong understanding of CPT, ICD-10, and HCPCS coding principles.
- Familiarity with Medicare, Medicaid, and major insurance plans.
- Proficiency with EMR and practice management systems.
- Strong attention to detail and ability to manage multiple tasks in a high-volume environment.
Location
N/A
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
No
Posted
2 weeks ago
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