Billing and Coding Specialist

Overview

This role is well suited for someone with a medical billing/coding background who is comfortable reviewing documentation, coding accurately, submitting high volumes of professional claims, and resolving billing issues while working both independently and collaboratively. 

Responsibilities

Primary Responsibilities 

• Review, manage and submit 75-100 CMS-1500 professional claims each day 

• Assign accurate procedure and diagnosis codes 

• Verify claim accuracy before submission 

• Review medical records to determine appropriate ICD-10 and CPT codes 

• Coordinate with other departments to obtain missing documentation 

• Resolve claim rejections and make claim corrections 

• Collaborate with revenue cycle teams to understand payer-specific billing guidelines and state insurance requirements 

Qualifications

Key Qualifications 

• Certificate or diploma from an accredited medical billing/coding program 

• Professional coding certification (required) 

• Knowledge of ICD-10 and CPT coding 

• Strong attention to detail and accuracy 

• Ability to multitask and prioritize work 

• Strong analytical and comprehension skills 

• Excellent verbal and written communication 

• Intermediate proficiency in Microsoft Excel 

• Work independently while maintaining timely communication with management 

• Positive attitude and ability to work collaboratively 

• Ability to consistently meet deadlines 

Preferred Experience 

• Medical billing and coding experience with CMS-1500 professional claims 

• Knowledge of insurance policies and reimbursement processes 

• Experience with out-of-network medical billing

Skills That Would Make a Strong Candidate 

• Medical billing and coding 

• ICD-10-CM and CPT coding 

• Revenue cycle management 

• Insurance verification and payer policies 

• Claim denial and rejection resolution 

• Medical records review 

• Microsoft Excel 

• Time management 

• Attention to detail 

• Communication and teamwork 

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