The Medical Coding and Billing Specialist supports oncology and radiation therapy billing operations by maintaining coding and billing rules in the practice management system, reviewing charges, and filing claims. This role works under the direct supervision of the team manager and collaborates with clinical, medical, and pre-authorization teams to ensure accurate reimbursement and compliance.
Key responsibilities include:
- Review and verify patient insurance coverage and eligibility for proton therapy treatments.
- Ensure charges for proton therapy, radiation therapy, and radiology services are entered accurately and on time.
- Generate and submit accurate claims to insurance payers.
- Monitor claims through the billing process and identify payer issues.
- Investigate and resolve claim rejections, denials, and appeals.
- Review insurance policies and regulations related to proton therapy billing.
- Maintain accurate billing records in patient files and computer systems.
- Review radiation oncology medical records for coding and billing accuracy.
- Educate clinical staff on documentation requirements.
- Respond to patient and insurance billing inquiries in a timely and professional manner.
- Stay current on industry trends, coding regulations, audits, and policy changes.
- Review charges in failed or hold status and take corrective action.
- Create and maintain ACE rules to reduce denials and manual review.
- Run ACE edits and file paper and electronic claims to payors.
- Communicate coding issues to leadership to support compliance and reduce denials.
Requirements & Qualifications
Education and experience
- Bachelor's degree preferred.
- Minimum 2 years of charge entry/billing experience required.
- 1+ year of prior authorization experience.
- Extensive knowledge of CPT, HCPCS, and ICD-9 coding.
- Medical insurance background required.
- Strong understanding of insurance billing guidelines, including Medicare and Medicaid.
- Working knowledge of hospice and other payer requirements.
- Knowledge of clinic office procedures, medical practice, and medical terminology.
Skills and competencies
- Proficiency in Microsoft Excel and strong computer skills.
- Ability to use end-user applications, databases, patient scheduling systems, and medical information systems.
- Strong verbal and written communication skills.
- Strong customer service skills.
- Ability to follow oral and written instructions.
- Ability to analyze data, solve problems, and use creative thinking.
- Strong multitasking, organization, and attention to detail.
- Ability to work effectively with all levels of management and colleagues.
- Professionalism, adaptability, initiative, and mature judgment.
- Ability to use websites, portals, and electronic tools to improve efficiency.
- Attendance is an essential job function.
Location
Nashville, Tennessee, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
1 week ago