Billing & Coding Specialist

Position Summary: 

The medical billing and coding specialist is responsible for ensuring accurate billing, timely submission of electronic and/or paper claims, monitoring claim status, researching rejections (denials) of Medicare, Medicaid, Medicaid Managed Care, and commercial insurance payers. The medical billing and coding specialist must possess critical thinking skills and understanding benefits/eligibility/authorizations of Medicare, Medicaid and commercial insurance. The Medical biller and coding would review claims before submission to correctly record contractual adjustments based on payer contracts or government regulations. In addition, the medical billing and coding specialist must demonstrate proficiency with the billing system to ensure all functionality is utilized for the utmost efficient processing of claims.

The Billing & Coding Specialist is responsible for ensuring accurate billing and timely submission of electronic and paper claims across various insurance payers, including Medicare, Medicaid, Medicaid Managed Care, and commercial insurers. This role includes monitoring claim statuses, researching and resolving claim rejections (denials), and ensuring compliance with payer contracts and government regulations. The specialist must demonstrate strong critical thinking skills and a thorough understanding of benefits, eligibility, and authorization processes for Medicare, Medicaid, and commercial insurance. Additionally, the Billing & Coding Specialist will review claims prior to submission to ensure proper contractual adjustments are made. Proficiency with the billing system is essential to maximize efficiency and ensure seamless claim processing.

Duties & Responsibilities:

• Accurately enter charges and payments into the Electronic Health Record (EHR), coordinating with providers as needed to clarify missing or incomplete information for proper claim processing. Verify patient eligibility and benefits for upfront collection on unmet deductibles and co-insurance.
• Enter charges accurately according to insurance payer agreements and contracts.
• Submit clean claims by attaching necessary documentation for payment processing and ensuring submission of all secondary claims as needed.
• Follow up with Medicare, Medicaid, Medicaid Managed Care, and Commercial insurance carriers on unpaid accounts identified through aging reports. Process appeals, either online or through paper submission, to resolve claim issues. Assist in reconciling deposits and patient collections.
• Support billing audits by providing necessary documentation and information as required.
• Handle refund requests in a timely and accurate manner.
• Address billing-related inquiries from patients and third-party payers.
• Respond to and manage correspondence related to patient accounts in a professional manner.
• Identify trends and carrier issues related to billing and reimbursements, and report findings to the Manager.
• Conduct research on billing issues and collaborate with the Manager to improve processes and achieve optimal results.
• Maintain patient confidentiality and safeguard sensitive information in compliance with HIPAA regulations.
• Monitor and ensure compliance with HIPAA confidentiality standards.
• Generate and review billing and financial reports, including monthly Accounts Receivable, income sources, and outstanding balances.
• Attend provider meetings and workshops as required for continuous professional development.
• Perform other duties as assigned to support the department and the company’s Mission, Vision, and Values.

Education/Experience:

• High school diploma or equivalent; a bachelor’s degree in accounting, healthcare administration, finance, business, or a related field is preferred.
• Minimum of two (2) years of experience in medical billing and coding for Home Health and Hospice.
• Knowledge of federal, in-network, and out-of-network payor systems.
• Familiarity with UB-04 and CMS-1500 forms.
• Understanding of Revenue Codes, CPT, HCPCS, Diagnosis, and Procedure Codes.
• Proficiency in ICD-10-CM, ICD-10-PCS, CPT-4/HCPCS, and modifier usage.
• CCS certification is preferred.
• Ability to work independently and follow through on assignments with minimal direction.
• Strong multitasking, prioritization, and time management skills.
• Excellent verbal and written communication skills.
• Proficiency in Microsoft Office Suite (Word, PowerPoint, Outlook, and Excel); experience with billing software is a plus.
• Strong analytical and problem-solving skills with the ability to strategize for better solutions.

Nice to Have:

• Experience in Home Health 

Benefits:

At Choice Healthcare Group, we value our employees and offer a comprehensive benefits package, including:

• Health Insurance – Available for full-time employees.
• Paid Time Off (PTO) – Vacation, sick leave, and holiday pay.
• 401(k) Retirement Plan – Employer-sponsored retirement savings.
• Flexible Scheduling – Work-life balance support.
• Career Growth Opportunities – Training and advancement potential.

Join our team and make a difference in the lives of those we serve!

Salary : $25 - $33