About This Role
The Medical Billing and Coding Specialist is responsible for medical coding, claims processing, surgery billing, payment posting, and insurance authorizations within a private practice setting. This role requires an experienced professional who can also provide backup support for other billing positions.
Responsibilities
- Review and process daily charges, including coding and correcting errors before submission
- Submit insurance claims and review rejected or returned claims for errors or additional corrections
- Correct and rebill claims as needed to ensure timely and accurate reimbursement
- Identify claims requiring documentation or note corrections and coordinate with the appropriate staff
- Work unbilled charges and resolve issues preventing claims from being submitted
- Print HCFA forms for insurance companies that do not accept electronic claims
- Process insurance exclusions and claims requiring additional review or manual processing
- Verify patient eligibility and active insurance coverage prior to scheduled surgeries
- Obtain insurance authorizations for surgical procedures, treatments, and medications when required
- Review surgery encounters to ensure CPT codes, diagnoses, and documentation are accurate
- Review completed encounters and submit claims once all information has been verified
- Post insurance payments and make billing corrections and account adjustments as needed
- Scan and process patient encounters and maintain accurate documentation
- Review and follow up on rejected, denied, outstanding, and unbilled claims
- Verify insurance eligibility and benefits as needed
- Coordinate with insurance companies regarding claim status, payment issues, and required documentation
- Assist with patient billing questions and account issues
- Process authorization requests and submit supporting clinical documentation
- Process and follow up on new patient referrals
- Request, prepare, and send medical records as required
- Prepare and send patient statements
- Answer incoming telephone calls when needed
- Provide backup front-office coverage, including checking patients in and out, scheduling appointments, and assisting with patient flow
- Travel between office locations when needed for backup coverage
- Maintain strict confidentiality regarding patients, employees, the practice, and all business information
Requirements
- Medical billing and coding experience required
- Knowledge of CPT, ICD-10, insurance claims, authorizations, denials, payment posting, and medical documentation
