Job Description

A Medical Coding and Billing Specialist is responsible for reviewing medical records, assigning accurate medical codes to diagnoses and procedures, preparing and submitting insurance claims, and ensuring timely reimbursement for healthcare services. This professional serves as a link between healthcare providers, patients, and insurance companies by ensuring that medical services are properly documented, coded, billed, and processed in accordance with applicable healthcare regulations and insurance requirements. Key responsibilities include reviewing patient records for accuracy and completeness, assigning appropriate ICD-10-CM, CPT, and HCPCS codes, submitting insurance claims, verifying patient insurance coverage, investigating claim denials, and resolving billing discrepancies. The specialist also maintains accurate billing records, follows up on outstanding claims, assists patients with billing inquiries, and ensures compliance with healthcare coding standards, payer policies, and patient privacy regulations. Key Responsibilities: Review medical records and clinical documentation to identify diagnoses, procedures, and services provided.Assign accurate diagnostic and procedural codes using ICD-10-CM, CPT, and HCPCS coding systems.Prepare, review, and submit medical claims to insurance companies and other payers.Verify patient insurance eligibility, coverage, and benefits.Review claim rejections and denials, identify errors, and submit corrected claims or appeals as appropriate.Process patient invoices, payments, and billing adjustments.Follow up on outstanding claims and unpaid balances to support timely reimbursement.Communicate with healthcare providers, insurance companies, and patients to resolve billing discrepancies.Maintain accurate patient billing records and documentation.Ensure compliance with applicable healthcare regulations, coding guidelines, payer requirements, and privacy standards.Required Skills and Qualifications: Knowledge of medical terminology, anatomy, and healthcare procedures.Familiarity with ICD-10-CM, CPT, and HCPCS coding systems.Understanding of medical billing procedures, insurance claims, and reimbursement processes.Attention to detail and strong analytical and organizational skills.Proficiency in electronic health records (EHRs) and medical billing software.Good communication, problem-solving, and time-management skills.Understanding of patient confidentiality and applicable healthcare privacy regulations.Ability to identify coding errors, investigate claim denials, and resolve billing issues efficiently.

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