Medical Billing and Coding Specialist

Job Description

Job Description

General Summary:

We are seeking a detail-oriented, highly organized Medical Billing and Coding Specialist to join our healthcare team. In this role, you will be responsible for translating complex patient medical records into standardized codes and managing the end-to-end insurance claims process. Your primary objective is to optimize our Revenue Cycle Management (RCM) by ensuring accurate, timely clinical documentation translation and securing maximum, compliant reimbursement from insurance payers.

We are a mission-driven organization focused on providing judgement-free sexual and reproductive healthcare, including abortion care, gynecologic services, gender-affirming care.

Key Responsibilities:

• Medical Coding: Review, analyze, and translate clinical documentation, physician notes, and laboratory reports into accurate alphanumeric codes using ICD-10-CM, CPT, and HCPCS Level II code sets.
• Claims Submission: Prepare, validate, and electronically transmit clean insurance claims to commercial insurance carriers, Medicare, and Medicaid.
• Insurance Verification: Verify patient insurance eligibility, benefits coverage, and coordinate necessary pre-authorizations or referrals prior to patient visits.
• Denials & Appeals Management: Monitor claim status, identify root causes for rejections or denials, correct errors, and submit formal appeals to insurance companies.
• Accounts Receivable (AR) Tracking: Maintain and follow up on outstanding patient and insurance aging balances to reduce days in AR.
• Patient Accounts & Support: Answer patient inquiries regarding statement balances, explain insurance Explanation of Benefits (EOBs), and establish authorized payment plans.
• Regulatory Compliance: Maintain absolute confidentiality and strictly adhere to HIPAA guidelines , OIG regulations, and internal compliance protocols.

Any other duties as assigned by the supervisor.

Skills/Qualifications:

1. Education: High School Diploma or equivalent required; an Associate Degree in Health Information Technology or a related field is highly preferred.
2. Experience: Minimum of 2-3 years of direct experience in medical billing and coding within a clinic, hospital, or billing agency with preferred expertise in women’s health (OBGYN, family planning)
3. Technical Skills: Proficiency with electronic health records ( EHR/EMR ) software (e.g.,AthenaHealth) and clearinghouse platforms.
4. Medical Knowledge: Understanding of medical terminology, anatomy, physiology, and diverse insurance payer guidelines.
5. Soft Skills: Excellent analytical thinking, strong mathematical accuracy, clear communication skills, and high attention to detail. Ability to work with minimal supervision and direction. Ability to work and interact with a diverse team and patient population.