Billing and Coding Specialist
LA CLINICA DE LOS CAMPESINOS INC•Sheboygan, WI
•Onsite
About The Position
Noble Community Clinics is seeking a detail-oriented Billing & Coding Specialist to join our team. This position plays an important role in supporting accurate coding, timely billing, claim resolution, and appropriate reimbursement while helping ensure compliance with healthcare regulations and payer requirements. The Billing & Coding Specialist will serve as a resource to providers and clinic staff on coding and billing questions, assist with claim and denial resolution, conduct coding audits, and support patient account management and overall revenue cycle operations.
Requirements
- Associate degree or equivalent from a two-year college or technical school; or six months to one year of related experience and/or training; or an equivalent combination of education and experience.
- Strong knowledge of medical billing, coding, reimbursement methodologies, and revenue cycle processes.
- Knowledge of ICD-10-CM, CPT, and HCPCS coding principles and guidelines.
- Understanding of healthcare reimbursement practices and payer requirements.
- Knowledge of clinical documentation requirements and their relationship to accurate coding and billing.
- Knowledge of federal and state healthcare regulations related to documentation, coding, and billing.
- Familiarity with Medicare, HMOs, PPOs, and other third-party payers.
- Strong analytical and problem-solving skills.
- Excellent attention to detail and accuracy.
- Strong organizational and time management skills with the ability to manage multiple priorities and meet deadlines.
- Excellent verbal and written communication skills.
- Proficiency with Microsoft Office applications and electronic health record (EHR) systems.
- CPR certification required.
Nice To Haves
- CPC or CCS-P certification preferred.
Responsibilities
- Review claims to ensure CPT, ICD-10-CM, and other applicable codes meet payer requirements and coding guidelines.
- Research and interpret coding-related denials and identify opportunities for resolution.
- Follow up on submitted and rejected claims and investigate billing discrepancies.
- Identify incomplete or inaccurate coding information and work with providers to obtain clarification or corrections.
- Research and apply federal, state, payer, and regulatory billing and coding requirements.
- Serve as a resource to providers and clinic staff regarding coding questions and concerns.
- Provide education related to coding changes, requirements, and identified coding issues.
- Conduct annual coding audits to evaluate the accuracy and completeness of ICD-10-CM diagnosis and CPT procedure coding.
- Support accurate and complete clinical documentation and coding practices.
- Collect, post, and manage patient account payments.
- Respond to patient questions regarding billing and statements.
- Establish payment plans and assist patients in managing outstanding balances.
- Provide professional and compassionate customer service when addressing billing questions.
- Support daily revenue cycle activities to promote accurate billing, coding compliance, and timely reimbursement.
- Identify trends or recurring issues that may impact billing accuracy or reimbursement.
- Collaborate with internal teams, providers, insurance representatives, and other partners to resolve billing and coding issues.
Benefits
- 20 days of PTO (accrual starts on day one)
- 8 paid holidays
- 401(k) with up to 5% employer match
- Medical, dental, and vision insurance
- Employer paid Short- and long-term disability
- Employer paid life insurance
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
Upload and Match Resume
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
