Certified Professional Medical Biller & Coder for a Hospitalist Group

Position Summary

The Certified Medical Biller and Coder is responsible for accurately reviewing medical documentation, assigning appropriate diagnosis and procedure codes, and supporting the billing process to ensure timely and compliant reimbursement. This role plays a critical part in maintaining the integrity of the revenue cycle by ensuring claims are coded correctly, submitted efficiently, and compliant with payer and regulatory guidelines.

The position requires strong knowledge of CPT, ICD-10-CM, HCPCS coding systems, payer requirements, and medical billing workflows.

Essential Duties and Responsibilities

• Review provider documentation and assign accurate CPT, ICD-10-CM, and HCPCS codes

• Ensure coding compliance with Medicare, Medicaid, and commercial payer guidelines

• Verify documentation supports medical necessity and appropriate coding

• Apply correct modifiers and place-of-service codes

• Prepare and review claims prior to submission to ensure clean claims

• Work with billing team to resolve claim denials, rejections, and payer edits

• Perform accounts receivable follow-up on unpaid or underpaid claims

• Communicate with providers regarding documentation clarification when necessary

• Assist with coding audits and compliance reviews

• Maintain up-to-date knowledge of coding updates and regulatory changes

• Ensure patient and billing information is handled in accordance with HIPAA regulations

Required Qualifications

• Active coding certification

• Minimum 4 years of experience in medical billing and coding

• Strong knowledge of CPT, ICD-10-CM, HCPCS Level II coding systems

• Experience with insurance claims submission and revenue cycle management

• Familiarity with Medicare and managed care billing guidelines

• Strong attention to detail and accuracy

• Ability to work independently in a remote environment

Preferred Qualifications

• Experience coding in multi-specialty practices

• Experience with primary care, pain management, wound care, hospital, or SNF coding

• Familiarity with EHR and billing platforms

• Experience with denial management and AR follow-up

Skills and Competencies

• Strong analytical and problem-solving skills

• Excellent attention to detail

• Knowledge of healthcare compliance regulations

• Strong written and verbal communication skills

• Ability to manage multiple tasks and meet deadlines

Work Environment

This is a fully remote position. The employee must have a reliable internet connection and the ability to work independently while maintaining productivity and communication with the team.