Medical Billing and Coding Specialist

Allies for Health and Wellbeing•Pittsburgh, PA

3h•$21 - $27•Onsite

About The Position

The Medical Billing and Coding Specialist is responsible for ensuring accurate coding, billing, claim submission, payment posting, denial management, and reimbursement of healthcare services. This position serves as a key member of the revenue cycle team by ensuring compliance with payer regulations, maximizing reimbursement, and supporting financial sustainability while maintaining excellent customer service. This position will report to the Chief Financial Officer. Mission To improve health and well-being, Allies provides integrated medical care, supportive human services, and community-based education for individuals living with, or at risk of HIV, viral hepatitis, and sexually transmitted infections. Vision Allies envisions a healthier community whereby people access integrated medical care and supportive human services in a respectful setting, free of stigma and discrimination.

Requirements

ICD-10-CM, CPT, HCPCS Level II, medical terminology, anatomy and physiology, insurance regulations, Medicare and Medicaid billing, commercial insurance billing, coordination of benefits, prior authorizations, appeals processes, HIPAA regulations.
Excellent attention to detail
Time management
Strong analytical skills
Problem-solving
Customer service
Written and verbal communication
Microsoft Office proficiency
EHR and billing software proficiency

Nice To Haves

Certification such as American Academy of Professional Coders: Certified Professional Coder (CPC), American Health Information Management Association: Certified Coding Specialist (CCS) or Certified Coding Associate (CCA)
Athena EMR experience
Associate’s degree in health information management, Medical Billing, or a related field
2-3 years of medical billing and coding experience

Responsibilities

Review clinical documentation for completeness and accuracy.
Review and assign appropriate ICD-10-CM, CPT, HCPCS Level II, and modifier codes.
Query providers when documentation requires clarification.
Stay current on coding guidelines and payer requirements.
Verify claim accuracy prior to submission.
Correct rejected claims promptly.
Monitor claim status through clearinghouses and payer portals.
Work denials by solving, tracking and recommending process improvements.
Correct coding or billing errors.
Prepare appeals with supporting documentation.
Track denial trends and recommend process improvements.
Post insurance payments accurately.
Post patient payments.
Reconcile electronic remittance advice (ERA) and explanation of benefits (EOB).
Identify payment variances and underpayments.
Escalate contract discrepancies.
Follow up on unpaid claims.
Resolve aged receivables.
Maintain assigned A/R work queues.
Document payer communications.
Answer billing questions.
Explain insurance benefits and patient responsibility.
Assist patients with payment arrangements.
Coordinate with front office regarding registration and insurance issues.
Maintain HIPAA compliance.
Follow payer billing guidelines.
Participate in internal audits.
Report on potential compliance concerns.
Collaborate with clinical teams to improve documentation.
Participate in revenue cycle meetings
Seek out up-to-date information about Allies’ programs and services, as well as relevant local, regional, and national health statistics that will inform and support our Mission
Improve job knowledge by remaining aware of new regulations and best practices; participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations
Embrace and exemplify organizational standards and guiding principles for processes, protocols, and utilization
Commit to Allies’ promise to sustain and extend diversity, equity, and inclusion
Contribute to efforts which build and reinforce Allies’ distinctive, effective, and ethical practices