The Insurance Biller and Coder is responsible for accurate medical coding, timely insurance claim submission, and efficient revenue cycle management. This role ensures that services are coded correctly, billed promptly, and compliant with applicable regulations.
Key responsibilities include:
- Review clinical documentation and assign ICD-10, CPT, and HCPCS codes accurately
- Ensure coding compliance with payer and regulatory guidelines
- Prepare, submit, and track insurance claims
- Follow up on unpaid or denied claims and initiate appeals when needed
- Verify patient insurance eligibility and benefits prior to billing
- Post payments and adjustments and reconcile accounts accurately
- Analyze denials and underpayments to identify trends and improve reimbursement
- Maintain accurate billing records and financial documentation
- Work with front desk and clinical teams to ensure complete charge capture
- Assist with audits and compliance reviews
- Communicate with insurance carriers, patients, and internal departments
- Educate patients on insurance coverage, billing statements, and payment responsibilities
Requirements & Qualifications
Core competencies
- Strong attention to detail and analytical thinking
- Excellent organizational and time-management skills
- Ability to work independently and meet deadlines
- Proficiency with billing software, EMR systems, and Microsoft Office
Knowledge requirements
- In-depth knowledge of medical coding standards, including ICD-10, CPT, and HCPCS
- Understanding of insurance plans, payer policies, and reimbursement processes
- Familiarity with healthcare compliance and privacy regulations
- Knowledge of denial management and appeals processes
Qualifications
- High school diploma or equivalent required
- Certification in medical coding such as CPC or CCS preferred
- Previous experience in medical billing and coding preferred
Location
South Carolina, US
Employment Type
Full-time
Experience Level
Entry Level
Remote work allowed
No
Posted
2 weeks ago