Billing & Coding Specialist

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The Billing & Coding Specialist is primarily responsible for processing insurance claims, which includes submitting claims, posting payments, reviewing denials and working with insurance companies to resolve payment issues. This position performs medical coding responsibilities as needed, including reviewing patient charts to ensure proper and accurate coding is on all claims.  As part of the essential functions of this role, the Billing & Coding Specialist

· Submits claims to insurance companies and meets timely filing requirements; Reviews claims data to ensure the assigned code(s) meet required legal and insurance rules

· Posts insurance payments manually and electronically and ensures all codes are being reimbursed according to payer contracts

· Reviews claim denials and contacts insurance companies for resolution; Reviews claim rejections and makes all necessary corrections to resubmit claims

· Assists patients with questions regarding Explanation of Benefits (EOBs), co-payments, personal balances, and all other questions regarding the billing process

· Collects, posts and manages patient account payments

· Knows and utilizes the different coding systems, including CPT and HCPS; Reviews patient charts, interprets medical information, and confirms that the appropriate ICD/CPT codes are assigned; Ensures all codes have been captured within the claim for services performed

Qualified Candidate will have a High school diploma or equivalent, current Medical Billing certification (CPB or CMBS), current Coding certification (CPC) and one (1) year of experience in a primary healthcare practice. Familiarity with EMR system (Medent) strong preferred. Candidate must be able to communicate clearly and professionally in writing and verbally, demonstrate familiarity with computers and MS Office software (Outlook, Word) and effective time management and organization skills. Sensitivity to HIV/AIDS, addiction and LGBT issues essential.

Job Type: Full-time

Required education: High School Diploma OR Equivalent

Required experience: Experience working in a primary care practice (1 year)

Required certification: CPB, or CMBS; CPC

Additional requirement(s): EMR systems (Medent Preferred)

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