JOB SUMMARY

The Medical Billing Specialist is responsible for the accuracy of the super bill/claim prior to transmission to payer, including validation of appropriate Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM).

DUTIES & RESPONSIBILITIES 

The Billing Specialist job description is intended to point out major responsibilities within the role, but it is not limited to these items. 

• Assign/remove CPT, HCPCS and modifiers as part of the super bill/claim validation process. 

• Prepare and review super bill/claims prior to submission. 

• Identify coding trends and opportunities to improve quality, efficiency and productivity.

• Checking each insurance payment for accuracy. 

• Ensure compliance with billing and payers’ guidelines. 

• Calling insurance companies regarding any discrepancy in payments if necessary 

• Researching and appealing denied claims. 

EDUCATION AND PROFESSIONAL EXPERIENCE 

(Licensures AND Certifications) 

• High school diploma or GED equivalent 

• Minimum of 1 year of experience as a medical biller. 

PROFESSIONAL COMPETENCIES 

• Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems. 

• Knowledge of CPT, ICD-10-CM and HCPCS codes. 

• Knowledge of coding principles and guidelines. 

• Knowledge of billing principles and guidelines. 

• Knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding, and billing for professional and technical services. 

• Excellent written and verbal communication skills 

• Prefer certification as any of the following - American Academy of Professional Coder (AAPC) Certified Professional Coder (CPC) or American Health Information Management Association (AHIMA) Certified Coding Specialist (CCS).

• Bilingual English and Spanish required.