Medical Biller & Coder

Medical Coder & Biller

Location: Remote

Experience :5-8 years

Shift Timing : 6:00 p.m. to 3:00 a.m.

About the Role

We are looking for a Medical Coder & Claims Integrity Specialist with strong U.S. medical coding and billing experience. The role will focus on reviewing clinical documentation, assigning accurate CPT/HCPCS/ICD-10 codes, creating and scrubbing claims, and ensuring claims meet payer-specific requirements before submission.

The ideal candidate will have strong knowledge of U.S. outpatient coding, payer guidelines, medical necessity, and claims compliance, with the ability to work closely with providers and billing teams.

Key Responsibilities

• Review provider notes, procedure reports, infusion/observation records, and supporting documentation for coding accuracy and completeness.
• Identify documentation gaps and provide clear feedback to providers to support accurate coding and medical necessity.
• Assign and validate CPT, HCPCS, ICD-10-CM, and modifiers based on documentation and payer requirements.
• Create and scrub professional claims before submission, ensuring compliance with NCCI, MUE, LCD/NCD, payer policies, and authorization requirements.
• Review specialty services including E/M, Spravato, ketamine treatments, sympathetic blocks, and infusion-related services.
• Verify eligibility, benefits, prior authorization, and other payer requirements before claim release.
• Hold or correct claims that are likely to result in denials due to coding, documentation, bundling, or medical necessity issues.
• Collaborate with billing/AR and quality teams to identify denial trends and improve first-pass claim acceptance.
• Support internal and payer audits while maintaining HIPAA and CMS/OIG compliance.

Required Qualifications

• Active coding certification such as CPC, CCS, CCS-P, CPC-P, or equivalent.
• 5+ years of U.S. professional fee coding and medical billing experience in an outpatient, specialty, or multi-specialty practice.
• Hands-on experience with chart review, claim creation, and claim scrubbing.
• Strong knowledge of CPT, HCPCS, ICD-10-CM, modifiers, NCCI, MUEs, and medical necessity guidelines.
• Experience with CMS-1500 claims, eligibility, prior authorizations, and commercial/Medicare Advantage payers.
• Strong written and verbal English communication skills.
• Ability to work remotely in a HIPAA-compliant environment and support U.S. Eastern Time hours.

Interested Candidates can share your CV to [email protected]