Job description
Job Title: Medical Coding and Billing Specialist
Job Location: On-site in Wellington, Florida
Job Purpose:
We are a medical practice management consulting firm with a mission to help practices and provider networks achieve sustainable financial and operational success. The Billing and Coding Specialist is responsible for the accurate coding, billing, claims processing, payment posting, and accounts receivable follow-up for medical services. This role ensures compliance with payer requirements, coding regulations, and company policies while maximizing reimbursement through timely claim submission, denial resolution, and effective communication with patients, providers, and insurance carriers.
Key Responsibilities:
- Accurately review, code, and process medical claims using ICD-10-CM, CPT, and HCPCS coding standards.
- Ensure claims are submitted timely, accurately, and in accordance with payer guidelines and standard billing cycles.
- Review claims for completeness, including patient demographics, insurance information, diagnosis codes, procedure codes, modifiers, provider information, and authorizations.
- Post insurance and patient payments accurately and reconcile payment discrepancies.
- Perform accounts receivable (A/R) follow-up to resolve outstanding balances and ensure timely reimbursement.
- Investigate and resolve claim denials, rejections, underpayments, and other payment issues.
- Prepare, submit, and monitor primary and secondary insurance claims.
- Verify patient insurance eligibility, benefits, authorizations, and coverage limitations as needed.
- Review deductible, coinsurance, copay, and patient responsibility amounts for accuracy.
- Generate and distribute patient statements for balances not covered by insurance.
- Establish payment arrangements and collect patient payments when appropriate.
- Respond professionally to patient inquiries regarding billing, insurance coverage, balances, deductibles, copays, coinsurance, and payment options.
- Obtain missing clinical documentation or patient information from providers, facilities, or other healthcare organizations as necessary to support claims processing.
- Review patient records for coding accuracy, HEDIS, MRA, and other quality reporting initiatives.
- Ensure compliance with federal, state, payer, HIPAA, and organizational billing and coding regulations.
- Maintain current knowledge of coding updates, payer policies, reimbursement guidelines, and regulatory requirements.
- Demonstrate proficiency with electronic health record (EHR) and practice management systems, including Athena, eClinical, Modernizing Medicine, AdvancedMD, or similar platforms.
- Utilize Microsoft Office applications, including Excel, Word, and PowerPoint, to prepare reports, analyze billing data, and maintain documentation.
- Maintain organized work areas while safeguarding confidential patient information.
- Follow established office procedures, infection control standards, and universal precautions where applicable.
- Collaborate effectively with providers, clinical staff, front office personnel, and insurance representatives to resolve billing and coding issues.
- Perform additional duties and special projects as assigned by management.
Qualifications Include:
License/Certification: None required. Certification as a Certified Professional Coder (CPC) and/or Certified Professional Biller (CPB) is preferred.
Education: High School or equivalent
Experience: Two years medical billing experience, equivalent education or combination of education and experience. Medical office experience preferred.
Critical Skills:
- Customer service
- Multi-tasking
- Time management
- Organization and attention to detail
- Ability to work under pressure
- Calming manner
- Discretion while maintaining patient confidentiality
- Problem-solving skills
- Good communication and interpersonal skills
- Knowledge of technical and mechanical equipment
- Able to escalate or resolve issues as necessary – communicate immediately with your supervisor regarding issues that you cannot resolve or situations that affect your ability to perform your job duties.
Additional Considerations:
- Must be available Monday to Friday during typical business hours
- Compensation is based on expertise, experience, character, work retention, and attention to detail
- Bilingual (Spanish) is highly preferred
- Benefits include health, dental, and vision insurance, as well as a PTO policy
If you or someone you know is a detail-oriented medical coder and biller with a passion for accuracy and the drive to excel, please apply to become a valuable member of our healthcare team. Join us in shaping the future of medical billing and contributing to the success of our growing organization.
Job Type: Full-time
Pay: $20.00 - $26.00 per hour
Benefits:
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Ability to Commute:
- Wellington, FL 33414 (Required)
Work Location: In person
