Medical Billing and Coding Specialist

Position Overview

The Medical Billing and Coding Specialist is responsible for reviewing patient medical records, assigning accurate medical codes, processing insurance claims, and ensuring timely reimbursement from insurance companies and patients. The role requires knowledge of medical billing procedures, coding guidelines, insurance requirements, and healthcare regulations.

Key Responsibilities

• Review patient medical records and clinical documentation to ensure accuracy and completeness.
• Assign appropriate medical codes for diagnoses, procedures, and services using ICD-10-CM, CPT, and HCPCS coding systems, as applicable.
• Prepare, submit, and follow up on medical insurance claims.
• Verify patient insurance eligibility, benefits, and coverage.
• Identify and correct claim errors, denials, and billing discrepancies.
• Communicate with insurance companies and healthcare providers to resolve claim issues.
• Follow up on outstanding accounts receivable and unpaid claims.
• Ensure compliance with applicable healthcare regulations, payer policies, and billing and coding guidelines.
• Maintain accurate patient billing records and documentation.
• Protect confidential patient information in accordance with HIPAA and other applicable privacy requirements.

Qualifications and Certifications

Candidates may hold one or more of the following certifications:

• Certified Professional Biller (CPB): Focuses on medical billing, insurance claims processing, reimbursement, payment posting, denial management, and accounts receivable follow-up.
• Certified Professional Coder (CPC): Focuses on medical coding, including assigning accurate diagnosis and procedure codes based on clinical documentation and applicable coding guidelines.
• Certified Billing and Coding Specialist (CBCS): Covers medical billing and coding, insurance claim processing, patient records, reimbursement procedures, and related administrative responsibilities.

Required Skills

• Knowledge of medical billing and coding procedures.
• Familiarity with ICD-10-CM, CPT, and HCPCS coding systems, as applicable to the role.
• Understanding of insurance claims processing, denials, and reimbursement procedures.
• Strong attention to detail and accuracy.
• Good analytical, organizational, and problem-solving skills.
• Ability to manage confidential information and meet productivity and quality standards.
• Effective written and verbal communication skills.

Preferred Experience

Previous experience in U.S. healthcare medical billing, coding, insurance claims processing, or revenue cycle management is preferred.