Medical Coder/Biller

5 days ago

Rocky Mount, United States GENERATIONS FAMILY PRACTICE Full time

The Medical Biller/Coder is responsible for accurately translating medical procedures, diagnoses, and services into universally accepted billing codes. They ensure that insurance claims are prepared and submitted in a timely and compliant manner, facilitating the revenue cycle and reimbursement process for healthcare providers.


· Assign appropriate CPT (Current Procedural Terminology), ICD (International Classification of Diseases), and HCPCS (Healthcare Common Procedure Coding System) codes to medical diagnoses, procedures, and services.

· Follow coding guidelines and conventions to ensure accuracy and compliance.

· Analyze medical records and provider documentation to identify relevant codes.

· Ensure coding reflects the medical necessity and completeness of services.

· Stay up to date with coding updates, guidelines, and regulations.

· Incorporate changes into coding practices to maintain compliance.

· Prepare and submit electronic and paper claims to insurance companies.

· Verify the accuracy of claim information, including patient demographics, insurance details, and coding.

· Monitor claim status and follow up on denied or rejected claims.

· Prepare and submit appeals for denied claims, including providing necessary documentation.

· Generate and send patient statements for outstanding balances.

· Answer patient inquiries regarding bills, insurance coverage, and payment options.

· Audit medical records for coding accuracy and compliance with regulatory requirements.

· Identify potential documentation deficiencies and work with healthcare providers for clarification.

· Ensure compliance with coding and billing regulations, including HIPAA, Medicare, and Medicaid guidelines.

· Adhere to ethical coding and billing practices to prevent fraud and abuse.

· Generate reports on coding and billing performance, including Key Performance Indicators (KPIs).

· Provide regular updates to management on billing and coding trends and issues.

· Collaborate with healthcare providers, clinical staff, and insurance companies to resolve coding and billing inquiries.


Education and/or Work Experience Requirements:


· High school diploma or equivalent; completion of a medical coding and billing program is preferred.

· Certification as a Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or similar coding certification is typically required.

· Knowledge of medical coding systems (CPT, ICD, HCPCS) and familiarity with medical terminology.

· Proficiency in medical billing software and electronic health record (EHR) systems.

· Strong attention to detail and analytical skills.

· Knowledge of healthcare compliance and regulations, including HIPAA.

· Excellent communication and interpersonal skills.

· Ability to work independently and as part of a team.

· Experience in medical billing and coding, typically 1-2 years, depending on the complexity of the role.

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