Medical Billing and Coding Specialist

Position Summary: The Medical Billing and Coding Specialist utilizes knowledge of insurance regulations, health insurance contracts, medical coding, and bookkeeping to perform various revenue cycle support activities.  These include but are not limited to medical coding, insurance verification, ensuring the accuracy of the information housed in the practice management system, preparing deposits, collecting, posting, and managing account payments, submitting accurate claims, and following up on accounts.  

Education/Qualifications: 

• High School Diploma, GED, or suitable equivalent 
• Coding Certification from APPC or AHIMA  
• Minimum five (5) years of medical coding work experience working in healthcare; 
• Knowledge of general accounting principles, revenue cycle processes, medical insurance, and associated regulations  
• A high degree of accuracy and attention to detail 
• Ability to manage multiple tasks/projects and deadlines simultaneously and to identify and resolve exceptions and interpret data; proficient in data entry 
• Customer service orientation and negotiation skills, including the ability to interface with third-party payers 
• Excellent communication skills, both verbal and written 
• Proficient computer skills, including Microsoft Office applications 

Essential Functions: 

Medical Coder Responsibilities: 

• Extracts relevant information from patient records and acts as liaison with providers and other parties to clarify information 
• Examines documents for missing data; corrects information as needed 
• Assigns CPT, HCPCS, ICD-10-CM, and DRG codes 
• Performs patient chart audits and provides coding feedback and education to the clinical team as needed 
• Answers questions, advises, and trains providers and staff on medical coding 
• Informs supervisor of issues with equipment and billing software, serves as point person for billing software issues complications, and submits service tickets through AMD. 
• Ensures compliance with medical coding policies and guidelines; understands the application of each code set 
• Maintains current knowledge regarding coding and diagnostic procedures 
• Works towards compliance in all aspects of coding, participates in compliance activities as requested, and conducts/participates in provider coding reviews and education as requested