Medical Billing and Coding Specialist

Job Description

Job Description

Medical Billing & Coding Specialist

Position Summary

The Medical Billing & Coding Specialist is responsible for managing insurance billing, claims processing, coding accuracy, and collection activities. This role ensures timely reimbursement, maintains compliance with coding guidelines, identifies documentation gaps, and works collaboratively with clinical and administrative teams to support accurate billing practices.

This is an on-site position and is not remote.

Education, Experience, and Certification Requirements

• High school diploma, GED, or equivalent required.
• Associate degree, bachelor’s degree, or relevant experience in medical records, healthcare administration, billing, or claims processing preferred.
• Experience with Kentucky Medicaid, medical billing, coding, insurance claims, or revenue cycle management preferred.
• Certification preferred:
  • Certified Coding Associate (CCA) through AHIMA
  • Certified Coding Specialist (CCS) through AHIMA
  • Certified Professional Coder (CPC) through AAPC
  • Or equivalent coding certification.

Essential Responsibilities and Duties

Billing & Claims Management

• Manage insurance billing and collections processes.
• Process, submit, track, and follow up on insurance claims to ensure accuracy and timely reimbursement.
• Review unpaid claims and resolve billing issues with insurance companies.
• Post Electronic Remittance Advice (ERA) payments and reconcile payment discrepancies.
• Maintain accurate records of billing and collection activities.
• Monitor accounts receivable and identify trends or issues impacting reimbursement.
• Generate monthly reports to track billing and collection performance.

Medical Coding & Documentation Review

• Assign accurate medical codes for reimbursement, compliance, and reporting purposes according to current coding guidelines.
• Review and verify documentation supporting diagnoses, procedures, and treatment outcomes.
• Analyze medical records and identify documentation deficiencies.
• Audit clinical documentation and coded data to ensure services rendered are supported and compliant.
• Identify coding discrepancies, billing concerns, and potential compliance issues.
• Research, analyze, and recommend corrective actions to prevent future coding errors.
• Ensure proper coding conventions and regulatory requirements are followed.
• Serve as a coding resource and subject matter expert for clinical and administrative staff.

Data & Reporting

• Research and analyze data needs related to reimbursement and billing performance.
• Maintain accurate billing records and documentation.
• Utilize Excel for reporting, including:
  • Sorting and filtering data
  • Pivot tables
  • VLOOKUP functions
  • Data analysis and reporting

Training & Support

• Provide guidance and support to other billing and coding staff.
• Assist with orientation, training, and mentoring of team members.
• Provide ongoing education and support related to coding standards and billing processes.
• Participate in special projects and additional duties as assigned.

Required Skills and Qualifications

• Strong attention to detail and excellent organizational skills.
• Ability to analyze medical documentation and identify discrepancies.
• Knowledge of insurance billing processes, claims management, and reimbursement practices.
• Strong understanding of medical terminology, coding guidelines, and healthcare compliance.
• Ability to work independently while maintaining accuracy and productivity.
• Excellent communication and customer service skills.
• Proficiency in Microsoft Excel and billing software systems.

Work Environment

• This position is performed on-site and is not eligible for remote work .
• Requires collaboration with clinical, administrative, and billing teams.
• Must maintain confidentiality and comply with HIPAA regulations.