Medical Biller and Coder Specialist

Job Title:
Medical Biller and Coder Specialist

Department: Revenue Cycle

Employment Type:
Part – Time

Work Arrangement:
Hybrid

Reports To: Revenue Cycle Director

The Medical Biller and Coder is responsible for accurately translating healthcare services and procedures into standardized medical codes and ensuring that claims are properly prepared, submitted, monitored, and reimbursed. This position plays an important role in the revenue cycle by maintaining accurate patient accounts, resolving billing issues, managing insurance claims, and ensuring compliance with applicable coding, billing, and privacy regulations.

The successful candidate will have strong knowledge of
ICD-10-CM, CPT, and HCPCS coding
, insurance billing procedures, claim submission requirements, payment posting, denial management, and accounts receivable follow-up.

• Review patient medical records, encounter notes, operative reports, diagnostic reports, and other clinical documentation to determine the appropriate diagnosis and procedure codes.
• Assign accurate
  ICD-10-CM diagnosis codes based on provider documentation.
• Assign appropriate
  CPT and HCPCS codes for services, procedures, supplies, and other billable items.
• Apply appropriate modifiers when supported by documentation and payer requirements.
• Verify that codes accurately reflect the sMedical Biller and Coder Specialister vices documented and meet applicable coding guidelines.
• Identify missing, incomplete, conflicting, or unclear documentation and communicate with appropriate clinical or administrative staff for clarification.
• Review documentation for medical necessity and coding consistency.
• Ensure that diagnoses and procedures are appropriately linked on claims.
• Maintain current knowledge of coding guidelines, payer-specific requirements, annual code changes, and applicable regulatory updates.
• Identify potential coding errors that could result in claim denials, delayed payments, or compliance concerns.
• Assist with internal coding audits and correction of identified coding discrepancies.
• Maintain accurate coding records and documentation.

• Enter and review patient demographic, insurance, and billing information for accuracy.
• Verify patient insurance eligibility and benefits when required.
• Confirm coverage, referral, authorization, and pre-certification requirements.
• Prepare and submit clean electronic and paper claims to insurance companies and other third-party payers.
• Review claims before submission to ensure required information, codes, modifiers, diagnoses, provider information, and insurance details are accurate.
• Submit corrected claims when errors or omissions are identified.
• Monitor submitted claims and follow up on claims that have not been processed within expected payer time frames.
• Review payer correspondence, explanation of benefits (EOBs), electronic remittance advice (ERAs), and other payment documentation.
• Post insurance and patient payments accurately to patient accounts.
• Apply contractual adjustments, write-offs, and other account adjustments according to established policies and payer contracts.
• Reconcile payments and investigate discrepancies between billed, allowed, paid, and outstanding amounts.
• Maintain accurate patient account balances.

• Review denied, rejected, and underpaid claims to determine the reason for nonpayment.
• Communicate with uplines and providers on billing or coding errors and resubmit claims as appropriate.
• Research payer policies and claim history to determine appropriate resolution.
• Prepare and submit appeals and supporting documentation for denied or underpaid claims.
• Follow up with insurance companies regarding outstanding claims and…