Medical Billing & Coding Specialist

The Medical Billing and Coding Specialist is responsible for accurately processing, reviewing, and submitting medical claims for a large multi-specialty physician practice. The role ensures timely reimbursement by verifying coding accuracy, resolving claim edits, following up on outstanding balances, and supporting patients and providers with billing inquiries. The Specialist collaborates closely with outsourced billing company employees, clinical departments, and payers to uphold revenue integrity and optimize financial performance.

Qualifications include a high school diploma or equivalent, a minimum of 10 years of medical billing experience preferably in a multi-specialty or large physician practice setting, and certification as a Certified Professional Coder (CPC) or similar credential. Candidates should have a strong understanding of CPT, ICD-10, and HCPCS coding principles, familiarity with Medicare, Medicaid, and major insurance plans, proficiency with EMR and practice management systems, strong attention to detail, and the ability to manage multiple tasks in a high-volume environment.

Essential duties include reviewing and correcting coding denials, reviewing charges for coding compliance, resolving claim edits and denials, following up on unpaid claims, processing adjustments and refunds, responding to patient billing inquiries, monitoring accounts receivable, collaborating with billing and clinical teams, maintaining knowledge of payer policies, supporting month-end close processes, and other related duties.

The role requires adherence to all applicable laws, regulations, standards, guidelines, and company policies, ethical conduct, protection of patient privacy and confidentiality, accurate documentation and record keeping, participation in assigned training, and engagement in risk management and incident reporting.