Medical Billing and Coding Specialist

Positive Impact Health Centers (PIHC) is a community leader in providing HIV prevention, care and treatment services. The PIHC model of care assures that persons with HIV have access to medical, pharmacy, dental, behavioral health and social services, providing the best opportunity for patients to achieve high-quality health outcomes. Job Summary The Medical Billing & Coding Specialist assures accurate and complete information is collected and reported to private insurance, Medicare, and Medicaid to help complete the revenue cycle. The specialist will scrub encounters for accurate coding prior to claim creation, follow-up on claim denials, obtain pre‑authorizations for certain procedures. The candidate should have knowledge of insurance regulations and medical coding with the goal of maximizing accurate third‑party billing. Responsibilities Accurately and timely submit medical claims to insurance companies and other payers Ensure codes are accurate and sequenced correctly in accordance with government and insurance regulations Review and analyze medical records to ensure appropriate coding of diagnoses and procedures. Follow up with providers on any documentation that is insufficient or unclear Assigns or reassigns CPT, HCPCS, and ICD-10-CM codes as needed Good understanding of E/M Guidelines Following up on unpaid claims and initiating appeals for denied ones within standard billing cycle timeframes Tracking the progress of claims through the clearinghouse and promptly address any issues Provides timely and professional customer service, resolve patient billing issues, answer questions from patients, facility staff, and third‑party vendors Review insurance and patient aging reports Staying updated on healthcare regulations, medical terminology, and coding practices Follows HIPAA guidelines when accessing and sharing patient information Tracking, reviewing, and reporting on billing metrics, trends, and periodic audits to ensure compliance and accuracy. Maintain compliance with all regulatory and accrediting institutions Perform other job‑related duties as assigned. Other Responsibilities Perform general office duties such as typing, filing, photocopying and report generation, answer telephone and emails, inventory, and ordering supplies. Abide by all state, district, and agency policies regarding confidentiality of patient information. Requirements Knowledgeable on insurance and reimbursement process. Good math and data entry (typing) skills. Exercises good judgement and discretion. Familiarity with HIPAA privacy requirements for patient information. Maintains and protects confidential information. Proficient in the use of computers and common office equipment. Good verbal and written communication skills. Basic understanding of medical ICD-10 codes and CPT medical billing codes. Good telephone and patient relationship skills. Detail oriented and ability to prioritize work. More experienced insurance billing specialists work with minimal direction and oversight. Basic Knowledge of Ryan White HIV/AIDS program is essential. Ability to collect, synthesize and research complex or diverse information. Ability to establish and maintain effective working relationships with a variety of clients who are living with HIV/AIDS to collect, verify, organize, and analyze information to determine eligibility for health insurance coverage Must be able to demonstrate ethical behavior in diverse situations and use critical thinking skills. Minimum Qualifications Associates Degree and two years of experience as a Medical Biller/Coder for Medical and Behavioral Health Services Bachelor's Degree in Business or related field preferred Any equivalent combination of training and experience (via AAPC or equivalent curriculum) which provides the required knowledge, skills, and abilities. License / Licensure Certified Billing/Coding Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is frequently required to sit and talk or hear. The employee is occasionally required to walk, use hands to finger, handle, or operate computers, objects, tools, or controls and reach with hands and arms. The employee must occasionally lift and/or move up to 30 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus. NOTES Positive Impact Health Centers, Inc., is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, or covered veteran status. Recreational drugs, weapons and violence are not permitted on agency property or at any agency events or programs. The above job description represents the general nature, primary duties and responsibilities, and qualifications for the work performed by employees within this job, but is not a comprehensive and exhaustive list. Employees may be required to perform other duties as assigned, and specific duties, responsibilities, and activities within the core nature of the job may change at any time with or without notice. Employees must be able to perform the essential functions of the job, as specified by the employing entity, with or without reasonable accommodation. Where permitted by applicable law, must have received or be willing to receive the COVID-19 vaccine by date of hire to be considered for all jobs, if not currently employed by Positive Impact Health Centers. #J-18808-Ljbffr