Billing and Coding Specialist

WHAT WE DO: ACME builds lasting relationships and provides a standard of excellence. Our culture is grounded in honor, integrity, family, and a strong commitment to inspiring hope. ACME is a management service organization that supports a network of healthcare entities across multiple states, delivering managerial and administrative services. These services include corporate administration, recruiting, revenue cycle management, scheduling, accounting, and case management. ACME tailors support services around each organization’s needs. Together, we’re creating more than operational success—we’re building a community of care.

JOB DESCRIPTION: The Billing and Coding Specialist is responsible for the accurate and compliant assignment of ICD-10 and CPT codes for all clinical services provided by ACME. This role supports the revenue cycle by ensuring timely claim submission, payer-specific accuracy, and adherence to all local and national coverage determinations. The ideal candidate demonstrates expertise in coding, regulatory guidelines, and EMR systems, with exceptional consistency, organization, and attention to detail.

KEY RESPONSIBILITIES:

Billing and Coding

• Assign accurate diagnosis (ICD-10) and procedure (CPT/HCPCS) codes in accordance with official coding guidelines, payer policies, and documentation.
• Ensure all coding aligns with Local Coverage Determinations (“LCDs”) and other CMS guidelines, referencing the CMS website and coding libraries regularly.
• Maintain and utilize a current library of coding books and digital references to verify proper code usage and combinations.
• Review and reconcile daily clinical encounters to ensure complete and timely capture of services for billing.
• Submit accurate, clean claims to government and commercial payers, applying knowledge of payer-specific rules and requirements.
• Understand and appropriately apply HCFA 1500 billing forms for professional claims.

Audit and Compliance

• Conduct regular internal audits to identify and correct coding discrepancies or documentation gaps.
• Educate providers and staff on documentation practices that support coding accuracy and compliance.
• Ensure HIPAA compliance and uphold standards for data security and regulatory reporting.
• Stay up to date on industry changes including payer bulletins, coding updates, and CMS regulations.

Systems & Communication

• Utilize EMR and billing systems proficiently (e.g., Epic, eClinicalWorks, or similar) for coding and encounter reconciliation.
• Review clinical narratives for completeness and extract relevant details to support accurate coding.
• Collaborate with front-end (registration/scheduling) and back-end (claims/AR) revenue cycle teams to resolve issues impacting reimbursement.
• Research coding references and payer policies quickly and independently to resolve denials or prevent claim rejections.
• Assist in tracking and resolving coding-related denials, ensuring timely follow-up and resubmission.

Communication and Collaboration:

• Communicate effectively with clinical staff, insurance companies, and patients regarding billing and coding issues.
• Provide excellent customer service and address patient inquiries in a timely and professional manner.
• Collaborate with the billing team to improve processes and efficiency.

QUALIFICATIONS:

• CPC (Certified Professional Coder) certification required; additional certifications such as APC are a plus.
• 3 years of professional experience in medical billing and coding.
• Strong knowledge of ICD-10, CPT, and HCPCS with emphasis on procedural coding and code pairing rules.
• Familiarity with LCDs and CMS policies, with ability to apply them in day-to-day coding.
• Experience with HCFA 1500 forms, payer-specific billing guidelines, and claims workflows.
• Demonstrated consistency, accuracy, and high attention to detail.
• Proficient in researching and applying complex coding and coverage guidelines across multiple payer types.
• Familiar with clinical documentation, EMRs, and the reconciliation of daily patient encounters across the revenue cycle.
• Meticulous accuracy in coding and billing to minimize errors.
• Effective problem-solving skills to resolve claim denials and payment discrepancies.
• Strong organizational skills and the ability to prioritize tasks and manage multiple deadlines.
• Ability to adapt to changes in coding guidelines and regulations.
• Willingness to learn new technologies and processes.

Job Type: Full-time

Pay: $45,000.00 - $52,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday
• No weekends

Work Location: In person

Salary : $45,000 - $52,000