About This Role
The Medical Billing and Coding Specialist is responsible for the accurate coding, billing, claims processing, payment posting, and accounts receivable follow-up for medical services. This role ensures compliance with payer requirements, coding regulations, and company policies while maximizing reimbursement through timely claim submission, denial resolution, and effective communication with patients, providers, and insurance carriers.
Responsibilities
- Accurately review, code, and process medical claims using ICD-10-CM, CPT, and HCPCS coding standards
- Ensure claims are submitted timely, accurately, and in accordance with payer guidelines and standard billing cycles
- Review claims for completeness, including patient demographics, insurance information, diagnosis codes, procedure codes, modifiers, provider information, and authorizations
- Post insurance and patient payments accurately and reconcile payment discrepancies
- Perform accounts receivable (A/R) follow-up to resolve outstanding balances and ensure timely reimbursement
- Investigate and resolve claim denials, rejections, underpayments, and other payment issues
- Prepare, submit, and monitor primary and secondary insurance claims
- Verify patient insurance eligibility, benefits, authorizations, and coverage limitations as needed
- Review deductible, coinsurance, copay, and patient responsibility amounts for accuracy
- Generate and distribute patient statements for balances not covered by insurance
- Establish payment arrangements and collect patient payments when appropriate
- Respond professionally to patient inquiries regarding billing, insurance coverage, balances, deductibles, copays, coinsurance, and payment options
- Obtain missing clinical documentation or patient information from providers, facilities, or other healthcare organizations as necessary to support claims processing
- Review patient records for coding accuracy, HEDIS, MRA, and other quality reporting initiatives
- Ensure compliance with federal, state, payer, HIPAA, and organizational billing and coding regulations
- Maintain current knowledge of coding updates, payer policies, reimbursement guidelines, and regulatory requirements
- Demonstrate proficiency with electronic health record (EHR) and practice management systems, including Athena, eClinical, Modernizing Medicine, AdvancedMD, or similar platforms
- Utilize Microsoft Office applications, including Excel, Word, and PowerPoint, to prepare reports, analyze billing data, and maintain documentation
- Maintain organized work areas while safeguarding confidential patient information
- Follow established office procedures, infection control standards, and universal precautions where applicable
