Medical Billing and Coding Specialist

About This Role

The Medical Billing and Coding Specialist collects and reports information to insurance providers to complete the revenue cycle. The specialist ensures accurate coding, follows up on denials, and obtains pre-authorizations, requiring knowledge of insurance regulations and medical coding to maximize accurate third-party billing.

Responsibilities

• Accurately and timely submit medical claims to insurance companies and other payers
• Ensure codes are accurate and sequenced correctly in accordance with government and insurance regulations
• Review and analyze medical records to ensure appropriate coding of diagnoses and procedures
• Follow up with providers on any documentation that is insufficient or unclear
• Assigns or reassigns CPT, HCPCS, and ICD-10-CM codes as needed
• Understand E/M Guidelines
• Follow up on unpaid claims and initiate appeals for denied ones within standard billing cycle timeframes
• Track the progress of claims through the clearinghouse and promptly address any issues
• Provide timely and professional customer service, resolve patient billing issues, and answer questions from patients, facility staff, and third-party vendors
• Review insurance and patient aging reports
• Stay updated on healthcare regulations, medical terminology, and coding practices
• Follow HIPAA guidelines when accessing and sharing patient information
• Track, review, and report on billing metrics, trends, and periodic audits to ensure compliance and accuracy
• Maintain compliance with all regulatory and accrediting institutions
• Perform other job-related duties as assigned
• Perform general office duties such as typing, filing, photocopying, and report generation
• Answer telephone and emails, inventory, and order supplies
• Abide by all state, district, and agency policies regarding confidentiality of patient information

Requirements

• Knowledgeable on insurance and reimbursement process
• Good math and data entry (typing) skills
• Exercises good judgement and discretion
• Familiarity with HIPAA privacy requirements for patient information
• Maintains and protects confidential information
• Proficient in the use of computers and common office equipment
• Good verbal and written communication skills
• Basic understanding of medical ICD 10 codes and CPT medical billing codes
• Good telephone and patient relationship skills
• Detail oriented and ability to prioritize work
• Basic Knowledge of Ryan White HIV/AIDS program is essential
• Ability to collect, synthesize and research complex or diverse information