Medical Billing and Coding Specialist (Clinic)

Premier Medical Resources•Houston, TX

4h•Hybrid

About The Position

Revenue Cycle Management is looking for a full-time Medical Billing and Coding Specialist to join their team. This is a hybrid opportunity after 30-90 day in-person training. The Medical Billing and Coding Specialist is responsible for reviewing patient medical records and accurately assigning ICD-10-CM, CPT, HCPCS, and applicable modifier codes in accordance with coding guidelines and payer requirements. This position ensures charges are accurately reflected on patient accounts, supports timely claim submission, and communicates with internal departments to resolve coding, documentation, and billing discrepancies.

Requirements

Knowledge of workers compensation, insurance verification, patient responsibility and prior authorization process
Knowledge of interpreting explanation of benefits (EOBs) and coordination of benefits (COB’s) processing
Thorough knowledge of ICD-10-CM, CPT, HCPCS, modifier use, and applicable coding guidelines.
Ability to interpret operative reports, physician documentation, and other medical records and translate documented services into accurate codes.
Knowledge of payer-specific coding requirements, regulatory standards, and medical necessity guidelines.
Ability to identify documentation deficiencies and communicate with providers and clinical staff to obtain clarification.
Proficiency in electronic billing systems, EMRs, coding resources, and the CMS-1500 claim form.
Demonstrates task-oriented and organizational skills.
Ability to adapt with flexibility.
Strong attention to detail, being careful about detail and thorough in completing work tasks.
Ability to work independently by guiding oneself with little or no supervision.
Ability to communicate professionally with outside parties.
Knowledge of PC and ability to use Microsoft office suite (PowerPoint, word, excel).
High School Diploma or GED
Three (3) years of medical billing and coding experience, including direct experience reviewing clinical documentation and assigning ICD-10-CM, CPT, HCPCS, and modifier codes.

Responsibilities

Reviews medical record documentation to accurately assign diagnosis, procedure, and modifier codes in accordance with ICD-10-CM, CPT, HCPCS, and applicable coding guidelines.
Validates diagnosis and procedure codes to ensure billing accuracy, regulatory compliance, and adherence to payer requirements; resolves routine discrepancies and escalates complex coding or documentation issues as appropriate.
Reviews clinical documentation, including operative reports, history and physicals, physician notes, and other medical records, to support accurate code assignment.
Ensures all billable services and charges are captured and accurately reflected on patient accounts.
Communicates effectively with providers, clinical staff, and other departments to obtain missing information and resolve coding or billing discrepancies.
Prepares and submits electronic and paper claims to commercial insurance carriers, governmental payers, and other third-party payers.
Monitors account status and identifies inconsistencies that may delay claim processing or reimbursement.
Investigates and resolves claim rejections, denials, and edits in a timely manner with a high degree of accuracy and attention to detail.
Maintains proficiency in electronic medical records (EMR) and billing systems while ensuring accurate and confidential patient information is maintained.
Maintains knowledge of current coding regulations, payer requirements, and industry best practices.
Performs other related tasks as needed.