Billing and Coding Specialist

RIVERSIDE RECOVERY OF TAMPA LLC•Tampa, FL

9d•$23 - $25

About The Position

The Billing and Coding Specialist reports accurate information to insurance companies to ensure clients of Riverside Recovery of Tampa are billed correctly. This role is a critical part of the financial cycle and requires attention to detail. The specialist works closely with the Billing and Coding Manager, Certified Professional Coder, and other departments to ensure medical claims are sent to insurers and clients. The position manages claim submissions, payment posting, payer requirements, claim follow-up, denials, appeals, and related billing data. It also helps maintain client account confidentiality and supports the team with verification of benefits as needed. The role requires maintaining continuing education to keep the CPC certification current.

Requirements

High school diploma, GED, or equivalent.
1–2 years of medical billing experience in substance abuse or mental health.
Completion of an accredited Medical Billing and Coding diploma program.
Excellent customer service skills.
Strong working knowledge of inpatient and outpatient medical coding.
Excellent computer and reporting skills, including proficiency in filtering, sorting, and grouping data sets using MS Excel.
Ability to manage multiple applications and records simultaneously while maintaining data integrity.
Familiarity with electronic medical records and claims or practice management systems.
Knowledge of applicable laws and regulations governing substance abuse treatment facilities and mental health, including HIPAA and Title 42, Part 2.

Responsibilities

Manage all claims submission and payment posting.
Ensure data is formatted, coded, and submitted accurately and compliantly.
Submit claims files to payers and post payments using Electronic Data Interchange (837p and 835ERA).
Identify and implement coding and submission requirements of individual payers and funding sources.
Monitor payer and clearinghouse submission reports and troubleshoot problems.
Monitor payer correspondence for updates and information affecting the claims process or reimbursement.
Monitor that electronic insurance claim billing is completed successfully each day.
Ensure claims are submitted in a timely manner.
Maintain the integrity of billing and claims-related data.
Analyze claims and billing data to identify trends and examine claim denial issues.
Communicate with health insurers regarding pending and unpaid claims.
Perform accounts receivable follow-up and denial work, research denials, submit appeals, and ensure payment is received on outstanding claims.
Follow up with third-party organizations after reviewing claims with overpayment or recoupment requests.
Post all insurance payments to patient accounts in CMD.
Assist with VA accounts as requested; the manager is responsible for those accounts.
Serve as the primary contact for payer-assigned claims and billing matters and maintain communication.
Understand claims data elements and structure related to substance abuse and mental health services and appropriate diagnoses.
Maintain client account privacy and notify clients when claims have not been paid in accordance with the accounts receivable policy.
Support Riverside Recovery’s mission, vision, values, standards, policies, procedures, operating instructions, confidentiality standards, and code of ethical behavior.
Work independently with good organization and time-management skills, multitask with little oversight, and communicate professionally and respectfully with all departments.
Protect the confidentiality of medical and financial records and follow HIPAA and confidentiality guidelines.
Assist the team with verification of benefits as needed.
Complete continuing education to keep CPC certification current.
Perform other duties as assigned.