SUMMARY
The Medical Billing/Coding Specialist is responsible for the accurate and timely processing of medical claims, including submission, follow-up, and resolution of denied or rejected claims. This role involves charge posting, reconciliation, maintaining patient financial records, and ensuring compliance with billing regulations and payer requirements. The specialist serves as a key liaison between providers, patients, and third-party payers.
Essential Duties and Responsibilities:
BILLING AND CLAIMS MANAGEMENT
· Ensure accurate and efficient processing of medical claims for submission to patients and third-party payers.
· Review and verify medical record documentation to support compliant billing practices.
· Submit claims electronically or manually, and follow up promptly on denied or rejected claims to resolve issues.
· Maintain knowledge of current medical billing practices, CPT/ICD coding, and billing compliance requirements.
· Post charges, perform account reconciliations, and support monthly audit and close-out procedures.
· Monitor aged accounts receivable and perform follow-up on unpaid claims in accordance with organizational policies.
· Research and resolve any billing discrepancies or delays in payment, including insurance underpayments and denials.
· Process adjustments, corrections, and refunds in alignment with policy and payer guidelines.
· Maintain the integrity and accuracy of patient financial files in the billing system.
INSURANCE COORDINATION AND REIMBURSEMENT
· Coordinate with insurance carriers to ensure proper billing and reimbursement.
· Review and interpret payer contracts and per diem agreements to ensure accurate payments.
· Stay up to date with changes in payer regulations, reimbursement policies, and federal/state billing requirements.
· Ensure compliance with Medicare and other regulatory billing standards.
· Respond to inquiries from insurance companies, patients, and providers regarding account status and billing questions.
QUALITY AND COMPLIANCE
· Participate in internal audits and monthly close processes to ensure billing accuracy.
· Examine work for accuracy, completeness, and compliance with established policies and procedures.
· Maintain confidentiality of all patient and organizational information in accordance with HIPAA and internal policies.
· Support quality improvement initiatives and assist with departmental reporting and monitoring activities.
· Contribute to the training and orientation of new employees as assigned.
Additional Benefits:
Competitive salary and comprehensive benefits package.
Up to a $7,500 hire-on bonus.
