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Medical Billing and Coding Specialist

2 months ago

Decatur, Georgia, United States Positive Impact Health Centers INC Full time
Job Summary

The Medical Billing and Coding Specialist plays a crucial role in ensuring accurate and complete information is collected and reported to private insurance, Medicare, and Medicaid to complete the revenue cycle. This position requires a strong understanding of insurance regulations and medical coding to maximize accurate third-party billing.

Key Responsibilities
  • Accurately and timely submit medical claims to insurance companies and other payers
  • Ensure codes are accurate and sequenced correctly in accordance with government and insurance regulations
  • Review and analyze medical records to ensure appropriate coding of diagnoses and procedures
  • Assigns or reassigns CPT, HCPCS, and ICD-10-CM codes as needed
  • Good understanding of E/M Guidelines
  • Following up on unpaid claims and initiating appeals for denied ones within standard billing cycle timeframes
  • Tracking the progress of claims through the clearinghouse and promptly address any issues
  • Provides timely and professional customer service, resolve patient billing issues, answer questions from patients, facility staff, and third-party vendors
  • Review insurance and patient aging reports
  • Staying updated on healthcare regulations, medical terminology, and coding practices
  • Follows HIPAA guidelines when accessing and sharing patient information
  • Tracking, reviewing, and reporting on billing metrics, trends, and periodic audits to ensure compliance and accuracy
  • Maintain compliance with all regulatory and accrediting institutions
Requirements
  • Knowledgeable on insurance and reimbursement process
  • Good math and data entry (typing) skills
  • Exercises good judgement and discretion
  • Familiarity with HIPAA privacy requirements for patient information. Maintains and protects confidential information
  • Proficient in the use of computers and common office equipment
  • Good verbal and written communication skills
  • Basic understanding of medical ICD 10 codes and CPT medical billing codes
  • Good telephone and patient relationship skills
  • Detail oriented and ability to prioritize work
Qualifications
  • Associate degree (bachelor's degree in business or related field preferred), and two years of experience as a Medical Biller/Coder for medical and behavioral health services
  • Or
  • Any equivalent combination of training and experience (via AAPC or equivalent curriculum) which provides the required knowledge, skills, and abilities