Certified Billing & Coding Specialist

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Job Summary :

As a Certified Billing and Coding Specialist, you will help manage the financial aspect of the Infusion & Specialty Pharmacy by translating medical procedures and diagnoses into standardized codes used for billing and insurance claims. You will ensure accurate and timely reimbursement for our Infusion & Specialty Pharmacy services by submitting claims, following up on denials, and maintaining patient records. This role requires strong technical and analytical skills, as well as knowledge of medical terminology, coding systems, and healthcare regulations.

Description



Job Summary :

As a Certified Billing and Coding Specialist, you will help manage the financial aspect of the Infusion & Specialty Pharmacy by translating medical procedures and diagnoses into standardized codes used for billing and insurance claims. You will ensure accurate and timely reimbursement for our Infusion & Specialty Pharmacy services by submitting claims, following up on denials, and maintaining patient records. This role requires strong technical and analytical skills, as well as knowledge of medical terminology, coding systems, and healthcare regulations.



Duties & Responsibilities

These include, but are not limited to:

• Processing electronic claims accurately, timely, and being persistent with aging accounts.
• Submitting appropriate documentation for adjustments to supervisor.
• Working on aging accounts daily to strive for all outstanding claims either being paid within 90 days or older than 90 days.
• Adhering to control standards established to guide the operation of the company.
• Identifying outstanding accounts receivable, including hospital LOA's, Single Case Agreements with insurance companies, house accounts, and inner company invoices.
• Processing credit card payments and refunds.
• Resolving billing issues with payors.
• Resolving customer credit issues.
• Processing all medical records requests in a timely manner.
• Notifying the supervisor of problem accounts.

• Having a billing and coding certificate is strongly recommended.
• Knowledge of HCPCS, ICD-10, and NDC coding.
• Knowledge of electronic billing.
• Experience working on open claims in Change, Availity, and other online Insurance Portals.
• Excellent calculation/math skills.
• Ability to prioritize and handle multiple tasks and projects concurrently.
• Strong interpersonal and communication skills.
• Software proficiency in Microsoft Office, Excel, Teams, Word, and Whats App.
• The ability to maintain confidentiality regarding sensitive billing documents is required.
• Strong attention to detail is a must.
• Proficient analytical skills are a must.
• Accounting experience is preferred.
• Experience as an Infusion & Specialty Pharmacy Technician is preferred.
• Experience with Wellsky’s Care Tend and/or CPR+ software is preferred.

• Spanish

• Seniority level
  
  Entry level

• Employment type
  
  Full-time

• Job function
  
  Accounting/Auditing and Finance
• Industries Hospitals and Health Care

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