Coding​/Billing Specialist

Essential Duties and Responsibilities Coding & Charge Capture Review clinical documentation to accurately assign CPT, ICD-10-CM, and HCPCS codes for professional services, procedures, injections, diagnostics, and ancillary services Ensure appropriate modifier usage and compliance with NCCI edits, LCDs, and payer-specific guidelines Validate medical necessity and documentation sufficiency prior to claim submission Collaborate with providers to clarify documentation and support accurate coding Billing & Claims Management Submit clean claims to commercial, Medicare, and Medicaid payers in a timely manner Monitor claim status and proactively follow up on unpaid, denied, or underpaid claims Identify root causes of denials and implement corrective actions to prevent recurrence Process corrections, resubmissions, and appeals as necessary Payment Posting & Reconciliation Post insurance payments, adjustments, and patient payments accurately Reconcile Explanation of Benefits (EOBs) with posted payments Identify and escalate discrepancies, underpayments, or payer variances Compliance & Quality Assurance Maintain compliance with federal, state, and payer billing regulations, including HIPAA Stay current on coding updates, payer policy changes, and reimbursement trends Assist with internal and external audits, providing documentation and explanations as needed Support revenue cycle reporting and performance improvement initiatives Patient & Team Support Respond professionally to patient billing inquiries and concerns Work collaboratively with front office, clinical staff, and leadership to improve workflows Maintain strict confidentiality of patient and financial information

Required Qualifications

Education:

High School Diploma or equivalent required Licensure / Certification (if applicable): CPC, CCS, or CBCS

Experience:

1-2 Years of experience in a medical office Knowledge, Skills, and Abilities:
Exceptional attention to detail and accuracy Strong analytical and problem-solving skills Ability to manage multiple tasks and deadlines independently Clear and professional written and verbal communication Collaborative mindset with a focus on continuous improvement Commitment to ethical billing practices and compliance Physical and Mental Requirements Ability to stand, walk, and move throughout the clinic for extended periods. Primarily office-based work environment- potential for remote options Prolonged periods of sitting and computer use Occasional lifting of office materials up to 15 pounds
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