Billing Specialist

The Medical Billing and Coding Specialist is responsible for accurately coding, billing, submitting and monitoring claims for wound care services provided to patients in skilled nursing facilities, nursing homes, long-term care facilities and other contracted healthcare settings. This position requires a strong understanding of wound care documentation, medical terminology, ICD-10-CM, CPT, HCPCS, Medicare Part B, commercial insurance requirements and healthcare reimbursement practices. The Billing Specialist will work closely with Nurse Practitioners, clinical staff, facility personnel and leadership to ensure that documentation appropriately supports the services billed and that claims are submitted accurately and timely.ResponsibilitiesAnalyze medical charts and patient records to abstract relevant clinical details.Assign alphanumeric codes accurately using ICD-10-CM, CPT, and HCPCS Level II systems for wound care services.Apply correct modifiers based on specialty guidelines and specific payer policies.Identify inconsistencies between clinical documentation and submitted codes and obtain clarification when necessary.Review medical necessity criteria against local and national coverage determinations (LCD/NCD).Verify insurance coverage, patient demographic information and pre-authorizations prior to billing.Investigate rejected claims to pinpoint the exact root causes of insurance denials.File formal appeals backed by strong, evidence-based coding rationale.Manage aging accounts receivable by following up regularly on delinquent balances.Enforce HIPAA compliance guidelines rigidly to safeguard Protected Health Information (PHI).Work proactively to reduce preventable denials and improve clean-claim rates.QualificationsHigh School Diploma or equivalent requiredMinimum 2–3 years of direct medical billing and coding experience within an outpatient or hospital setting with a preference for wound care coding and billing.Strong medical terminology and medical-record review skills.Proficiency with Electronic Health Record (EHR) platforms.High-level attention to detail, organization and analytical ability.Excellent communication skills.Proven ability to use technology effectively.Ability to manage multiple priorities and meet billing deadlines.Preferred QualificationsActive credentials, such as Certified Professional Coder (CPC) or Certified Coding Specialist (CCS).Proven ability to identify documentation and coding issues that may result in claim denials, underpayments, compliance concerns or lost reimbursement.Experience in billing for Long Term Care or Skilled Nursing Care.Knowledge pertaining to debridement coding and wound care procedures.Experience with skin substitute and cellular/tissue-based product billing.Billing and Coding experience for Medicare Part B and Medicare Advantage. #J-18808-Ljbffr Priority Dispatch Corp.