Medical Billing & Coding Specialist

Job Description

Job Description

Position Summary

The Medical Billing & Coding Specialist is responsible for accurate medical coding, timely claim submission, and effective follow-up to ensure optimal reimbursement. This role plays a critical part in the revenue cycle by preparing, reviewing, and submitting clean claims, resolving unpaid or denied claims, and maintaining compliance with coding and payer requirements. The ideal candidate is detail-oriented, self-motivated, and experienced in working with a variety of insurance plans.

Key Responsibilities

• Prepare, review, and submit clean claims to insurance carriers electronically in a timely manner.

• Review and correct denied or unpaid claims and resubmit as appropriate.

• Identify, investigate, and resolve billing discrepancies and payer issues.

• Apply accurate CPT codes, ICD-10 diagnoses, and appropriate modifiers in accordance with payer guidelines.

• Perform account follow-up and manage appeals to ensure proper reimbursement.

• Prepare, review, and send patient statements.

• Adhere to established timelines for billing, filing, and payment cycles.

• Maintain accurate and complete documentation in billing systems and EMRs.

• Communicate effectively with insurance companies, internal teams, and patients as needed.

• Work collaboratively with clinical and administrative teams to resolve coding and billing issues.

• Support credentialing activities as needed (preferred, not required).

Qualifications Required

• Minimum of 2 years of medical billing and coding experience.

• Strong knowledge of CPT coding, ICD-10 coding, and appropriate modifiers.

• Experience with claim submission, account follow-up, and appeals.

• Working knowledge of insurance plans.

• High attention to detail with the ability to produce accurate, high-quality work.

• Strong time management and organizational skills with the ability to manage multiple priorities.

• Excellent written and verbal communication skills.

• Strong interpersonal skills and ability to work effectively as part of a team.

• Self-starter with a focused, goal-driven mindset and proven results.