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.
High school diploma or equivalent required
Associate's or Bachelor's degree preferred (Health Information Management, Business, or related field)
Minimum of two (2) years' experience in healthcare coding, billing, patient accounting, or revenue cycle operations
Hospital or physician billing experience preferred
CPC, CCS-P, CCSP, or equivalent coding certification
Certification required within 6 months of hire date
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
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.