Physician Billing & Coding Specialist I

Day (United States of America) Physician Billing & Coding Specialist I The Physician Billing & Coding Specialist I is responsible for supporting the professional billing lifecycle, including physician coding, charge review and reconciliation, billing, and A/R 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.

Education

• High school diploma or equivalent required
• Associate’s or Bachelor’s degree preferred (Health Information Management, Business, or related field) Experience
• Minimum of two (2) years’ experience in healthcare coding, billing, patient accounting, or revenue cycle operations
• Hospital or physician billing experience preferred Certifications (Required)
• CPC, CCS-P, CCSP, or equivalent coding certification
• Certification required within 6 months of hire date SKILLS, EXPERIENCE AND LICENSURE:
• Knowledge of ICD-10, CPT, HCPCS, HCFA-1500, and professional billing practices
• Knowledge of Local Coverage Determinations and National Coverage Determinations (LCD/NCD) medical necessity requirements
• Knowledge of regulatory and third-party payer requirements
• Professionalism in interpersonal communication skills with physicians, colleagues, and ancillary departments required
• The ability to organize, prioritize, analyze, and implement daily tasks; must be a self-starter
• The ability to handle multiple responsibilities and tasks in stressful situations
• The ability to maintain confidentiality; knowledge of HIPAA laws
• Proficiency with billing systems, specifically Epic DUTIES AND RESPONSIBILITIES: Physician Coding & Documentation Integrity
• Review physician medical records to extract and assign appropriate ICD-10, CPT, and HCPCS codes for professional billing.
• Maintain knowledge of Local and National Coverage Determinations (LCD/NCD), payer policies, and regulatory changes.
• Comply with internal coding standards, government regulations, and third-party payer requirements. Billing & Accounts Receivable Management
• Process professional claims accurately and timely in accordance with payer-specific guidelines.
• Correct and resubmit rejected, denied, or pending claims; follow up with insurance carriers to ensure timely payment.
• Analyze remittances and explanation of benefits (EOBs) to determine appropriate payment application, adjustments, or patient responsibility.
• Assist with internal and external payer and compliance audits
• Assign and track follow-up dates to prevent timely-filing issues. Other Responsibilities
• Maintain accurate documentation and notes in billing system.
• Work assigned account work queues daily to ensure timely resolution.
• Respond to written and electronic correspondence within required timeframes.
• Adhere strictly to HIPAA, organizational ethics standards, and corporate compliance policies.
• Maintain confidentiality of all patient and financial information.
• Demonstrate ethical and professional conduct in all interactions.
• Assist coworkers and departments as needed.
• Maintain flexibility to support multiple functional Revenue Cycle areas.
• Perform additional duties as assigned by management.