Medical Coder / Biller
Department: Back Office
Reports To: Revenue Cycle Manager
Employment Type: Full-time
Job Summary
The Medical Coder / Biller will be responsible for reviewing provider documentation, assigning accurate CPT, ICD‑10, and HCPCS codes, submitting claims, resolving denials, and managing accounts receivable. This position requires strong ENT‑specific coding knowledge, excellent communication skills, and the ability to work collaboratively with providers and administrative staff.
Key Responsibilities:
· Review clinical documentation and assign accurate CPT, ICD‑10, and HCPCS codes for ENT office visits, procedures, and surgeries
· Ensure proper use of modifiers (e.g., -25, -50, RT/LT, -59) specific to ENT coding
· Verify medical necessity and coding specificity prior to claim submission
· Maintain up-to-date knowledge of ENT-specific coding and payer rules
·Submit claims electronically and monitor claim status for timely reimbursement
· Identify denial trends and root causes and recommend corrective actions
· Prepare and submit corrected claims and formal appeals with supporting documentation
· Track appeal outcomes and follow up with insurance companies as needed
· Communicate recurring denial issues to billing staff and providers
Stay current on payer policies, coding updates, and ENT‑specific billing rules
Verify insurance coverage and assist with prior authorization workflows when needed
Compliance & Quality
· Ensure compliance with CMS, payer contracts, and clinic policies
· Support internal and external audits by providing documentation and coding rationale
· Maintain HIPAA compliance and patient confidentiality at all times
Collaboration & Communication
· Work closely with providers to clarify documentation and improve coding accuracy
· Collaborate with front desk, billing, and authorization teams to prevent denials
· Educate staff on common ENT coding and denial issues as needed
Required Qualifications
· High school diploma or equivalent (Associate’s degree preferred)
· Certified Professional Coder (CPC), CCS, or equivalent certification required
· 2+ years of medical coding experience, preferably in ENT, surgical specialties, or multi-specialty practices
· Strong knowledge of CPT, ICD-10-CM, HCPCS, and modifier usage
· Experience working insurance denials and appeals
Preferred Qualifications
· Prior experience in an ENT or otolaryngology clinic
· Familiarity with audiology and hearing aid coding
· Knowledge of common ENT procedures (e.g., nasal endoscopy, laryngoscopy, sinus surgery, tonsillectomy, ear procedures)
· Experience with EHR and practice management systems
· Understanding of prior authorizations and medical necessity guidelines
Skills & Competencies
· Strong attention to detail and accuracy
· Excellent analytical and problem-solving skills
· Effective written and verbal communication
· Ability to manage multiple priorities and meet deadlines
· Independent work style with strong follow-through
Benefits:
- 401(k)
- Dental insurance
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
People with a criminal record are encouraged to apply
Work Location: In person
