Billing and Coding Specialist

Job Summary

The Coder’s primary objective is to review medical documentation and select the appropriate ICD-10 diagnosis code(s) for medical billing. The Billers’ primary objective is to review accounts for the appropriate documentation, create and submit medical claims. The biller should also ensure the claims are accurate and billed in a timely manner.

Principal Duties and Responsibilities

• Review medical documentation to assign ICD-10 codes accurately for Pre-Authorization and Billing.
• Processes all claims that require submissions via Invoice or HCFA-1500 forms in a timely and accurate manner.
• Monitors all coding and billing grids ensuring timely filing requirements are met.
• Monitors the electronic billing rejections, correct any errors, and resubmit the claims.
• Handles all resubmissions and Secondary billing in a timely and accurate manner.
• Follow up on accounts in PBR to be sure that all necessary information is on file prior to submitting the claim.
• Completes daily department reports in a timely manner.
• Demonstrates excellent customer service skills, strong written and verbal communication as well as possessing a professional telephone manner.
• Other job functions as determined necessary and as assigned by management.

This is not an exhaustive list of duties or functions and may not necessarily comprise all the "essential functions" for purposes of the ADA.

Expected Areas of Competence (i.e. KSAs)

• Ability to code claims using ICD 10 Diagnosis codes and bill claims
• Knowledge or understanding of Commercial insurance, Medicare, Medicaid, and other governmental and private insurance.
• Medical terminology and health insurance background required.
• Understanding of health insurance concepts and benefit design required.
• Excellent customer service skills, analytical problem-solving skills, strong written and verbal communication skills, professional telephone manner and well organized.
• Able to work with balancing team and individual responsibilities.
• Experience using Microsoft Office tools such as Word and Excel.
• Ability to learn and use proprietary programs such as FileNet, A/S 400, IFM.

Education/ Experience Requirements

• 3 years of ICD-10 Coding. 
• 3 years of medical billing.
• CPC certification preferred. 

Travel Requirements

Less than 5%