The Physician Billing & Coding Specialist I is responsible for supporting the professional billing lifecycle, including physician coding, charge review and reconciliation, billing, and accounts receivable 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.
This position requires knowledge of Local and National Coverage Determinations, payer policies, regulatory changes, and compliance with internal coding standards, government regulations, and third-party payer requirements. The specialist processes professional claims accurately and timely, corrects and resubmits rejected or denied claims, analyzes remittances and explanation of benefits, assists with internal and external audits, and maintains documentation and notes in the billing system.
The role also demands professionalism in communication, the ability to organize and prioritize multiple tasks, maintain confidentiality according to HIPAA laws, and proficiency with billing systems, specifically Epic.
- High school diploma or equivalent required
- Associate's or Bachelor's degree preferred (Health Information Management, Business, or related field)
- Minimum of two (2) years' experience in healthcare coding, billing, patient accounting, or revenue cycle operations
- Hospital or physician billing experience preferred
- Certification (CPC, CCS-P, CCSP, or equivalent) required within 6 months of hire
- Knowledge of ICD-10, CPT, HCPCS, HCFA-1500, and professional billing practices
- Knowledge of Local and National Coverage Determinations (LCD/NCD) and medical necessity requirements
- Understanding of regulatory and third-party payer requirements
- Strong interpersonal communication skills, professionalism, and ability to handle multiple tasks
- Ability to maintain confidentiality and knowledge of HIPAA laws
- Proficiency with Epic billing system
Location
Florida, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
2 weeks ago