MSO - Coding and Billing Specialist

Job Description

Job Description

About CCNC

From the mountains to the coast, from large cities to small towns, Community Care of North Carolina is transforming health care. Informed by statewide data and predictive analytics, community-based care-managers work with local physicians and diverse teams of health professionals to develop whole-person plans of care that connect people to the right local resources and increase equity and access to high quality care.

CCNC Mission Statement

To improve the health and quality of life for all North Carolinians by building supporting better community-based healthcare delivery systems.

Position Summary

We are seeking a detailed-oriented and experienced MSO Coding and Billing Specialist with strong coding expertise and hands-on experience across multiple Electronic Medical Record (EMR) systems. This role is responsible for ensuring accurate coding, billing, and reimbursement processes while maintaining compliance with payer and regulatory requirements. The ideal candidate brings a deep understanding of medical coding standards and can quickly adapt to different EMR platforms.

Essential Functions

• Review, code, and submit medical claims accurately using appropriate CPT, ICD-10, and HCPCS codes
• Utilize extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Centers for Medicare and Medicaid Services (CMS) for accurate and optimized assignment and sequencing of diagnostic and procedural codes.
• Able to provide guidance and training on appropriate modifiers according to guidelines. This includes and is not limited to deciding when the modifiers are appropriate to add onto CPT codes.
• Be able to work directly with practices and internal provider relations and EHR specialists to educate and improve the accuracy, completeness, specificity and appropriateness of diagnosis codes, E&M coding based on services rendered and assign appropriate modifiers.
• Able to identify existing or potential problems, gather relevant information, and analyze the information to identify probable causes of problems. Applies knowledge, experience, and common sense and considers alternatives when deciding on the best potential solutions.
• Ensure compliance with federal, state, and payer-specific billing and coding regulations
• Work across multiple EMR systems to manage billing workflows, patient accounts, and claim submissions
• Identify and resolve coding discrepancies, billing errors, and claim denials
• Monitor claim status, follow up on unpaid claims, and coordinate appeals as needed
• Provides measurable, actionable solutions to providers and internal teams that will result in improved accuracy for documentation and coding practices.
• Be a player-coach, serving as a coding expert for your team as well as external and senior stakeholders.
• Interpret, apply, and explain applicable rules and regulations.
• Abide by the American Health Information Management Association (AHIMA) Standards of Ethical Coding and adhere to official coding guidelines.
• Research coding requirements for new and existing contracts.
• Collaborate with clinical and administrative staff to ensure accurate documentation supports coding and billing
• Maintain up-to-date knowledge of coding guidelines, payer policies, and industry best practices
• Generate and analyze billing reports to identify trends and improve revenue cycle performance.
• Coordinating with teams across the organization to relay information.
• Maintains strict confidentiality and follows HIPAA compliance.
• Other job duties as required.

Qualifications

• Certified Professional Coder (CPC), CCS, or equivalent certification required.
• AAPC or AHIMA coding certification preferred.
• 3+ years of medical billing and coding experience
• Demonstrated experience working with multiple EMR/EHR systems (e.g., Epic, TriMed, Athenahealth, eClinicalWorks, etc.)
• Strong knowledge of CPT, ICD-10, and HCPCS coding systems
• Experience with claim submission, denial management, and revenue cycle processes
• High attention to detail and accuracy
• Demonstrated adaptability, handles day to day work challenges confidently, is willing and able to adjust to multiple demands, shifting priorities; shows resilience in the face of challenges, demonstrates flexibility.

Knowledge, Skills, and Abilities

• Experience working effectively with common office software, coding software, EMR and abstracting systems
• Computer skills including fluency in MC Office applications
• Proficient in ICD-10 CM, HCPCS and CPT coding
• Knowledge of Medicaid, Medicare, managed care, and commercial insurance.
• Embrace our corporate culture, including our vision, mission, and values
• Displays Emotional Intelligence (EI) skills through ability to respond versus react, accept, and utilize feedback, and maintain positive, respectful work relationships through self-management and strategic relationship building
• Forward thinking and solution-oriented; able to turn challenges into opportunities and take actions to improve business processes
• Able to manage multiple tasks/projects, including prioritizing duties, meeting deadlines, and providing on-time responses to management, supervisor, and co-worker requests
• Demonstrate a commitment to detail, accuracy, and thoroughness
• Punctual, reliable, able to begin work as scheduled and attend mandatory meetings
• Analytical skills, sound judgment and self-direction are necessary as independent decisions and problem solving are required

Working Conditions

• Routinely there may be some minor physical inconveniences or discomforts in the work setting, including sitting for moderate periods of time
• Must be able to utilize office equipment, computer, keyboard, and phone with or without assistive devices
• Repetitive wrist motion and occasional lifting/carrying of up to 25 pounds

Why Join Us

• Make a meaningful impact on youth and families across North Carolina
• Work with a supportive and collaborative care team
• Competitive Benefits Package effective first day of employment
• Opportunities for growth, training, and bonus incentives*

Ready to improve the health and quality of life of all North Carolinians by building and supporting better community-based health care delivery systems?

• Apply today and join us in delivering compassionate care that makes a difference.