Certified Coder and Billing Specialist

Job Summary:

A private healthcare company is seeking a detail-oriented and highly organized Billing and Coding Specialist to accurately and efficiently manage the medical billing and coding processes. This individual will be responsible for assigning appropriate diagnostic and procedural codes, ensuring accurate claim submission, resolving billing discrepancies, and maintaining compliance with all relevant regulations and payer guidelines. The ideal candidate will possess a strong understanding of medical terminology, anatomy, physiology, and coding systems, as well as excellent communication and problem-solving skills.

Responsibilities:

• Coding:
  • Review patient medical records (e.g., physician notes, operative reports, lab results) to accurately assign ICD-10-CM, CPT, and HCPCS codes for diagnoses and procedures.
  • Ensure coding accuracy and completeness in accordance with official coding guidelines, payer policies, and regulatory requirements.
  • Stay up-to-date on coding changes, updates, and new regulations through ongoing education and resources.
  • Communicate with physicians and other healthcare professionals to clarify documentation and ensure accurate coding.
• Billing:
  • Prepare and submit electronic and paper claims to insurance companies and patients.
  • Verify patient insurance eligibility and benefits.
  • Follow-up on outstanding claims, investigate denials, and initiate appropriate appeals.
  • Process payments, post charges, and reconcile accounts.
  • Identify and resolve billing errors and discrepancies promptly.
  • Respond to patient and payer inquiries regarding billing issues.
  • Generate and analyze billing reports as needed.
• Compliance:
  • Adhere to all HIPAA regulations regarding patient privacy and data security.
  • Maintain a thorough understanding of payer-specific billing guidelines and requirements.
  • Stay informed about changes in federal, state, and local regulations related to medical billing and coding.
  • Participate in internal audits and quality assurance activities.
• Other Duties:
  • Maintain organized and accurate records.
  • Assist with other administrative tasks as needed.
  • Collaborate effectively with other members of the billing and administrative teams.
  • Participate in training and development opportunities to enhance job skills and knowledge.

Qualifications:

• Education: High school diploma or equivalent required; Associate's or Bachelor's degree in healthcare administration, medical billing and coding, or a related field preferred.
• Certification: Current and valid certification as a Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or other relevant coding credential from AAPC or AHIMA is highly preferred.
• Experience: Minimum of three years of experience in medical billing and coding within a physician practice.
• Knowledge and Skills:
  • Thorough understanding of ICD-10-CM, CPT, and HCPCS coding systems and guidelines.
  • Familiarity with medical terminology, anatomy, and physiology.
  • Proficiency in electronic health record (EHR) and practice management systems.
  • Experience with electronic claim submission and payer portals.
  • Strong knowledge of insurance regulations, including Medicare, Medicaid, and commercial payers.
  • Excellent data entry and typing skills with a high degree of accuracy.
  • Strong problem-solving and analytical skills.
  • Excellent communication (both written and verbal) and interpersonal skills.
  • Ability to work independently and as part of a team.
  • Strong organizational and time management skills with the ability to prioritize tasks and meet deadlines.
  • Commitment to maintaining confidentiality and ethical standards.
  • Grapevine, Texas with the possibility of being Hybrid.
  • Familiarity with local payer requirements and regulations in the Grapevine and Fort Worth, Texas area is a plus.