Responsible for accurately reviewing, coding, billing, and submitting medical claims while ensuring compliance with federal regulations, payer requirements, and company policies. This role supports reimbursement, coding integrity, documentation review, claims processing, and payer follow-up.
- Review patient encounters and provider documentation for accuracy, completeness, and coding/billing compliance.
- Assign and validate ICD-10-CM, CPT, HCPCS Level II codes, and applicable modifiers.
- Generate, review, and scrub claims before submission to reduce denials and improve reimbursement.
- Submit electronic and paper claims as required by payer guidelines.
- Monitor documentation for coding compliance and request clarification or corrections when needed.
- Maintain HIPAA privacy and security compliance.
- Stay current on coding updates, payer policies, NCCI edits, Medicare regulations, and reimbursement requirements.
- Identify billing trends, reimbursement issues, coding discrepancies, and denial patterns and report findings to leadership.
- Review insurance policies, payer guidelines, and reimbursement methodologies to ensure proper billing.
- Assist with MIPS, quality reporting, and other value-based reimbursement initiatives.
- Work denied, rejected, or returned claims and coordinate corrections and resubmissions.
- Collaborate with providers, clinical staff, and revenue cycle staff to improve documentation quality and billing accuracy.
- Maintain productivity and quality standards.
- Participate in internal audits, compliance initiatives, and coding education.
- Perform additional duties and special projects as assigned.
Requirements & Qualifications
- High school diploma or equivalent required.
- Medical billing and/or coding certification preferred, such as CPC, CCS-P, CCA, RHIT, RHIA, or equivalent.
- Minimum of 2 years of medical billing and coding experience preferred.
- Strong knowledge of ICD-10-CM, CPT, HCPCS, modifiers, payer guidelines, and reimbursement methodologies.
- Experience with EHR systems, practice management software, and clearinghouses.
- Knowledge of Medicare, Medicaid, commercial insurance, and value-based reimbursement programs.
- Strong analytical, organizational, and problem-solving skills.
- Excellent written and verbal communication skills.
- Ability to manage multiple priorities with accuracy and attention to detail.
Benefits & Perks
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Location
Wichita, Kansas, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
3 weeks ago