Medical Billing & Coding Specialist

Under the direction of the Revenue Cycle Manager, the Medical Billing and Coding Specialist translates clinical documentation into standardized codes to ensure accurate and timely claim submission and reimbursement from insurance payers. The role is responsible for resolving complex billing issues, managing accounts receivable (A/R), and partnering with providers to improve documentation quality.

Key responsibilities include:

• Analyze patient medical records and assign CPT, ICD-10-CM, and HCPCS Level II codes for diagnoses and procedures.
• Use coding software, medical dictionaries, and classification manuals to ensure accuracy and compliance with federal regulations.
• Collaborate with clinical staff to clarify documentation for medical necessity and accurate coding.
• Assist with billing, chart auditing, and medical records management.
• Prepare and submit clean electronic and paper claims to primary, secondary, and tertiary payers.
• Post payments manually or electronically, track A/R aging reports, and reconcile ERA/EOB remittances.
• Monitor claim status, address rejections, and draft appeals for denied claims.
• Respond to questions about costs, insurance coverage, and payment plans.
• Ensure compliance with HIPAA regulations, CMS guidelines, and state and federal healthcare laws.
• Assist with insurance payer medical record requests.
• Participate in the organization’s quality improvement program and uphold core values of accountability, communication, team unity, and trust.