Job DescriptionMedical Billing & Coding Specialist
Position Summary
The Medical Billing & Coding Specialist is responsible for ensuring the accurate and timely billing of outpatient speech-language pathology and occupational therapy services. This position reviews therapist-selected codes for completeness and payer compliance, submits insurance claims, manages accounts receivable, resolves denials, and serves as a billing resource for providers regarding insurance and reimbursement questions.
Essential Duties and Responsibilities
Medical Billing
- Review patient encounters for billing completeness and accuracy prior to claim submission.
- Submit electronic claims to commercial insurance, Medicare, Medicaid, and other third-party payers.
- Monitor claim status and promptly resolve claim rejections and denials.
- Correct billing errors and resubmit claims as appropriate.
- Post insurance payments, patient payments, contractual adjustments, and other transactions.
- Generate and submit patient statements.
- Maintain timely claim filing in accordance with payer deadlines.
Revenue Cycle Management
- Monitor accounts receivable and insurance aging reports.
- Follow up with insurance companies regarding unpaid or underpaid claims.
- Prepare and submit appeals for denied claims.
- Identify billing trends and recommend process improvements to reduce denials and improve reimbursement.
- Assist with month-end billing reconciliation and reporting.
Coding Support & Compliance
- Review therapist-selected ICD-10-CM, CPT, and HCPCS codes for accuracy, completeness, and payer-specific requirements.
- Consult with therapists regarding documentation or coding discrepancies before claim submission.
- Research unusual billing scenarios and payer policies to support appropriate reimbursement.
- Serve as a resource for providers regarding billing regulations, modifier usage, National Correct Coding Initiative (NCCI) edits, and payer-specific requirements.
- Stay current on Medicare, Medicaid, and commercial insurance billing rules affecting outpatient therapy services.
- Participate in internal chart audits and billing quality assurance activities.
Insurance Coordination
- Verify insurance eligibility and benefits as needed.
- Assist with prior authorization tracking and payer documentation requirements.
- Communicate with scheduling and clinical staff regarding authorization limitations or insurance concerns.
Patient Financial Services
- Respond to patient billing inquiries professionally and courteously.
- Explain insurance benefits, balances, and payment options.
- Process payment arrangements in accordance with clinic policies.
Compliance
- Maintain HIPAA compliance and patient confidentiality.
- Adhere to all federal, state, and payer regulations governing outpatient therapy billing.
- Maintain accurate documentation within the electronic medical record (EMR) and billing system.
Required Qualifications
- High school diploma or GED required.
- Minimum of two years of medical billing experience in an outpatient healthcare setting.
- Knowledge of ICD-10-CM, CPT, HCPCS, modifiers, and insurance billing processes.
- Experience with Medicare, Medicaid, and commercial insurance billing.
- Proficiency with electronic medical records (EMR) and medical billing software.
- Strong organizational skills and exceptional attention to detail.
- Excellent written and verbal communication skills.
- Ability to work independently while collaborating effectively with providers and administrative staff.
Preferred Qualifications
- Experience billing for speech-language pathology, occupational therapy, or physical therapy.
- Certified Professional Biller (CPB), Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification.
- Experience with prior authorizations and outpatient therapy payer requirements.
Knowledge, Skills & Abilities
- Strong understanding of outpatient therapy billing regulations.
- Ability to analyze denials and identify root causes.
- Knowledge of Medicare therapy billing requirements and payer-specific guidelines.
- Strong customer service and conflict resolution skills.
- Ability to maintain accuracy while managing multiple priorities.
- Proficiency with Microsoft Office and billing software.
Performance Expectations
Success in this role is measured by:
- Timely and accurate claim submission.
- Low claim rejection and denial rates.
- Timely resolution of accounts receivable.
- Compliance with payer regulations and HIPAA.
- Effective collaboration with therapists and administrative staff.
- High-quality customer service for patients and insurance representatives.
Pay: $19.00 - $25.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
Work Location: In person
