Medical Biller

Job Summary

The Medical Biller/Coder is responsible for accurately translating medical procedures, diagnoses, and services into universally accepted billing codes. This role ensures insurance claims are prepared and submitted in a timely and compliant manner to support the revenue cycle and reimbursement process for healthcare providers.

Key Responsibilities

• Assign CPT, ICD, and HCPCS codes to medical diagnoses, procedures, and services.
• Follow coding guidelines and conventions to ensure accuracy and compliance.
• Review medical records and provider documentation to identify relevant codes.
• Keep current on coding updates, guidelines, and regulations and apply changes to coding practices.
• Prepare and submit electronic and paper claims to insurance companies.
• Verify claim accuracy, including patient demographics, insurance details, and coding.
• Monitor claim status and follow up on denied or rejected claims.
• Prepare and submit appeals for denied claims with supporting documentation.
• Generate and send patient statements for outstanding balances.
• Answer patient inquiries regarding bills, insurance coverage, and payment options.
• Audit medical records for coding accuracy and compliance with regulatory requirements.
• Identify documentation deficiencies and work with providers for clarification.
• Verify or modify CPT and diagnosis coding for each patient visit.
• Verify or modify insurance information for each patient.
• Post insurance charges with the correct date and PCP.
• Post self-pay charges and apply patient payments to accounts.
• Post EOBs for HMO/private payers and confirm balances are correct.
• Apply copayments and deductibles to patient accounts.
• Write notes regarding copayment and deductible balances for front desk staff.
• Generate reports on coding and billing performance, including KPIs.
• Provide updates to management on billing and coding trends and issues.
• Collaborate with providers, clinical staff, insurance companies, patients, and parents to resolve billing and coding questions.
• Maintain clear communication regarding documentation and coding concerns.
• Call insurance companies or parents when questions arise regarding claims.
• Ensure compliance with HIPAA and ethical billing practices.