Coding Compliance Specialist researches and develops the pre-certification insurance policy standards and criteria used by case management and utilization reviewers that will ensure that requested medical services are appropriate and medically necessary. Collaborates with medical professionals to resolve questions about policy development and standards. Being a Coding Compliance Specialist assigns correct ICD, CPT, or other coding assignments for medical procedures that support policy standards in claims systems. Provides expertise and solutions to users regarding the appropriate coding for claims. Additionally, Coding Compliance Specialist has broad knowledge of medical coding systems. May require an associate degree in healthcare administration, a related field, or equivalent. Requires AAPC Certified Professional Coder (CPC). May alternatively require Certified Coding Specialist (CCS) certification. Typically reports to a manager. The Coding Compliance Specialist occasionally directed in several aspects of the work. Gaining exposure to some of the complex tasks within the job function. To be a Coding Compliance Specialist typically requires 2 -4 years of related experience. (Copyright 2024 Salary.com)
Job Summary:
We are seeking a detail-oriented and experienced LEAD Medical Biller to join our team. The Medical Biller will be responsible for accurately coding and billing medical claims, ensuring timely reimbursement, and maintaining patient records. The ideal candidate will have a strong understanding of medical billing procedures, coding systems, and insurance regulations, and assist in creating systems.
Duties:
- Review and verify accuracy of medical documentation, including patient demographics, diagnoses, procedures, and treatments
- Assign appropriate medical codes (ICD-10, ICD-9, CPT) to ensure proper billing and reimbursement
- Submit claims electronically or by mail to insurance companies or government agencies
- Follow up on unpaid or denied claims and resolve any billing discrepancies or issues
- Communicate with patients, insurance companies, and healthcare providers to address billing inquiries or disputes
- Maintain patient records and ensure confidentiality of sensitive information
- Stay up-to-date with changes in medical billing regulations and coding systems
Experience:
- Minimum of 2 years of experience in medical billing or related field
- Proficient in medical coding systems (ICD-10, ICD-9) and billing software, knowledge of ECW is a plus.
- Knowledge of medical terminology and procedures
- Familiarity with insurance guidelines and reimbursement processes
- Strong attention to detail and accuracy in coding and billing practices
- Excellent communication skills to effectively interact with patients, insurance companies, and healthcare providers
Skills:
- Medical records management
- Medical collection procedures
- Proficiency in ICD-10 coding system
- Knowledge of medical billing software/systems
- Understanding of medical office operations and workflows
- Familiarity with coding systems such as ICD-9 and CPT
- Experience with DRG (Diagnosis Related Group) coding
If you are a skilled Medical Biller looking for a challenging role in a dynamic healthcare setting, we encourage you to apply. Join our team and contribute to providing quality care to our patients while ensuring accurate and timely reimbursement for our services.
Job Type: Full-time
Experience:
Ability to Commute:
Work Location: In person
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