Physician Billing & Coding Specialist I

Physician Billing & Coding Specialist I

The Physician Billing & Coding Specialist I is responsible for supporting the professional billing lifecycle, including physician coding, charge review and reconciliation, billing, and A/R follow-up. This role reviews clinical documentation for accurate ICD-10, CPT, and HCPCS code assignment; ensures compliance with regulatory and payer requirements; resolves patient and third-party account issues; and serves as a liaison between providers, payers, and patients to promote timely, accurate reimbursement.

Education

High school diploma or equivalent required

Associate's or Bachelor's degree preferred (Health Information Management, Business, or related field)

Experience

Minimum of two (2) years' experience in healthcare coding, billing, patient accounting, or revenue cycle operations

Hospital or physician billing experience preferred

Certifications (Required)

CPC, CCS-P, CCSP, or equivalent coding certification

Certification required within 6 months of hire date

Skills, Experience and Licensure:

Knowledge of ICD-10, CPT, HCPCS, HCFA-1500, and professional billing practices

Knowledge of Local Coverage Determinations and National Coverage Determinations (LCD/NCD) medical necessity requirements

Knowledge of regulatory and third-party payer requirements

Professionalism in interpersonal communication skills with physicians, colleagues, and ancillary departments required

The ability to organize, prioritize, analyze, and implement daily tasks; must be a self-starter

The ability to handle multiple responsibilities and tasks in stressful situations

The ability to maintain confidentiality; knowledge of HIPAA laws

Proficiency with billing systems, specifically Epic

Duties and Responsibilities:

Physician Coding & Documentation Integrity

Review physician medical records to extract and assign appropriate ICD-10, CPT, and HCPCS codes for professional billing.

Maintain knowledge of Local and National Coverage Determinations (LCD/NCD), payer policies, and regulatory changes.

Comply with internal coding standards, government regulations, and third-party payer requirements.

Billing & Accounts Receivable Management

Process professional claims accurately and timely in accordance with payer-specific guidelines.

Correct and resubmit rejected, denied, or pending claims; follow up with insurance carriers to ensure timely payment.

Analyze remittances and explanation of benefits (EOBs) to determine appropriate payment application, adjustments, or patient responsibility.

Assist with internal and external payer and compliance audits

Assign and track follow-up dates to prevent timely-filing issues.

Other Responsibilities

Maintain accurate documentation and notes in billing system.

Work assigned account work queues daily to ensure timely resolution.

Respond to written and electronic correspondence within required timeframes.

Adhere strictly to HIPAA, organizational ethics standards, and corporate compliance policies.

Maintain confidentiality of all patient and financial information.

Demonstrate ethical and professional conduct in all interactions.

Assist coworkers and departments as needed.

Maintain flexibility to support multiple functional Revenue Cycle areas.

Perform additional duties as assigned by management.