Coding Specialist

What You’ll Do (Key Responsibilities) Assign and sequence appropriate ICD‑10‑CM diagnosis codes and CPT/HCPCS procedure codes based on clinical documentation. Translate patient transport data into billable charges, ensuring that the level of service billed perfectly matches the medical necessity documented in the Electronic Patient Care Report (ePCR). Maintain a sharp, up‑to‑date understanding of coding bundling, modifiers, and global periods to proactively prevent claim denials. Clinical Coding & Charge Entry (35% of your time) Assign and sequence appropriate ICD‑10‑CM diagnosis codes and CPT/HCPCS procedure codes based on clinical documentation. Translate patient transport data into billable charges, ensuring that the level of service billed perfectly matches the medical necessity documented in the Electronic Patient Care Report (ePCR). Maintain a sharp, up‑to‑date understanding of coding bundling, modifiers, and global periods to proactively prevent claim denials. Demographic & Insurance Verification (25% of your time) Conduct comprehensive audits of patient information, including legal name, address, date of birth, and guarantor details for every claim. Verify insurance eligibility and primary/secondary/tertiary coverage using clearinghouses and payer portals. Ensure all insurance details are entered flawlessly to minimize "front-end" rejections. Documentation Compliance & "Send Backs" (20% of your time) Review ePCRs for signature compliance and missing clinical documentation. Identify and flag incomplete records, preparing "send back" tasks for clinical staff or providers to ensure documentation meets legal and billing guidelines. Monitor the "Send Back" queue to ensure corrections are returned and processed quickly. Claims Resolution & Rebilling (15% of your time) Research and resolve basic claim edits or denials related to coding or demographic discrepancies. Update account notes to accurately reflect the status of rebilled claims and any actions taken to resolve payment delays. Systems Maintenance & Team Collaboration (5% of your time) Perform critical data corrections within HealthEMS and other ePCR programs. Coordinate with providers, clients, and internal colleagues via email and Slack to resolve billing hurdles. Stay current on company processes and industry regulatory updates by actively participating in department meetings. Experience What We’re Looking For At least 3 years of experience with Medical Insurance. Knowledge, Skills, & Abilities Technical Knowledge: Proficiency in ICD‑10‑CM coding; familiarity with CMS (Medicare/Medicaid) billing rules, private payer regulations, and medical necessity for emergency/non‑emergency transport. Core Skills: High-speed, high‑accuracy data entry; advanced problem-solving; professional written communication; ability to interpret complex medical narratives. Key Abilities: A strong ability to maintain deep focus and accuracy during repetitive tasks, and the organizational skill to manage multiple "queues" or task lists simultaneously. #J-18808-Ljbffr Emergent Health Partners