Day (United States of America)
Physician Billing & Coding Specialist I
The Physician Billing & Coding Specialist I is responsible for supporting the professional billing lifecycle, including physician coding, charge review and reconciliation, billing, and A/R follow-up. This role reviews clinical documentation for accurate ICD-10, CPT, and HCPCS code assignment; ensures compliance with regulatory and payer requirements; resolves patient and third-party account issues; and serves as a liaison between providers, payers, and patients to promote timely, accurate reimbursement.
Education
- High school diploma or equivalent required
- Associate's or Bachelor's degree preferred (Health Information Management, Business, or related field)
Experience
- Minimum of two (2) years' experience in healthcare coding, billing, patient accounting, or revenue
cycle operations
- Hospital or physician billing experience preferred
Certifications (Required)
- CPC, CCS-P, CCSP, or equivalent coding certification
- Certification required within 6 months of hire date
SKILLS, EXPERIENCE AND LICENSURE:
- Knowledge of ICD-10, CPT, HCPCS, HCFA-1500, and professional billing practices
- Knowledge of Local Coverage Determinations and National Coverage Determinations (LCD/NCD)
medical necessity requirements
- Knowledge of regulatory and third-party payer requirements
- Professionalism in interpersonal communication skills with physicians, colleagues, and ancillary
departments required
- The ability to organize, prioritize, analyze, and implement daily tasks; must be a self-starter
- The ability to handle multiple responsibilities and tasks in stressful situations
- The ability to maintain confidentiality; knowledge of HIPAA laws
- Proficiency with billing systems, specifically Epic
DUTIES AND RESPONSIBILITIES:
Physician Coding & Documentation Integrity
- Review physician medical records to extract and assign appropriate ICD-10, CPT, and HCPCS codes
for professional billing.
- Maintain knowledge of Local and National Coverage Determinations (LCD/NCD), payer policies, and
regulatory changes.
- Comply with internal coding standards, government regulations, and third-party payer requirements.
Billing & Accounts Receivable Management
- Process professional claims accurately and timely in accordance with payer-specific guidelines.
- Correct and resubmit rejected, denied, or pending claims; follow up with insurance carriers to ensure
timely payment.
- Analyze remittances and explanation of benefits (EOBs) to determine appropriate payment application, adjustments, or patient responsibility. · Assist with internal and external payer and compliance audits · Assign and track follow-up dates to prevent timely-filing issues. Other Responsibilities · Maintain accurate documentation and notes in billing system. · Work assigned account work queues daily to ensure timely resolution. · Respond to written and electronic correspondence within required timeframes. · Adhere strictly to HIPAA, organizational ethics standards, and corporate compliance policies. · Maintain confidentiality of all patient and financial information. · Demonstrate ethical and professional conduct in all interactions. · Assist coworkers and departments as needed. · Maintain flexibility to support multiple functional Revenue Cycle areas. · Perform additional duties as assigned by management.