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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