Coding Compliance Specialist researches and develops the pre-certification insurance policy standards and criteria used by case management and utilization reviewers that will ensure that requested medical services are appropriate and medically necessary. Collaborates with medical professionals to resolve questions about policy development and standards. Being a Coding Compliance Specialist assigns correct ICD, CPT, or other coding assignments for medical procedures that support policy standards in claims systems. Provides expertise and solutions to users regarding the appropriate coding for claims. Additionally, Coding Compliance Specialist has broad knowledge of medical coding systems. May require an associate degree in healthcare administration, a related field, or equivalent. Requires AAPC Certified Professional Coder (CPC). May alternatively require Certified Coding Specialist (CCS) certification. Typically reports to a manager. The Coding Compliance Specialist occasionally directed in several aspects of the work. Gaining exposure to some of the complex tasks within the job function. To be a Coding Compliance Specialist typically requires 2 -4 years of related experience. (Copyright 2024 Salary.com)
About us
Texas Modern Gastroenterology is a rapidly growing Gastroenterology practice looking for a Medical Billing and Coding Specialist in Sulphur Springs, TX. We are professional, agile and fast-paced.
Our work environment includes:
Responsibilities:
- Responsiblle for interpreting and coding Gastroenterology services provided utilizing standardized medical coding practices ensuring that all claims are billed and collections meet all government or payer mandated procedures for accuracy, integrity, and compliance
-Review and analyze medical records to ensure accurate coding and billing
- Assign appropriate ICD-10, DRG, and CPT codes to medical procedures and diagnoses
- Verify patient insurance coverage and process claims for reimbursement
- Communicate with healthcare providers to obtain missing or incomplete documentation
- Follow up on denied or rejected claims and resolve billing discrepancies
- Maintain patient confidentiality and adhere to HIPAA regulations
- Stay updated on changes in coding guidelines and regulations
Requirements:
- Proven experience as a Medical Biller or in a similar role (2-3years required)
- Proficient in ICD-10 coding and DRG classification systems
- Familiarity with ICD-9 codes is a plus
- Experience in Gastroenterology medical billing and coding (preferred)
- Knowledge of medical terminology, anatomy, and physiology
- Strong attention to detail and accuracy in coding and billing processes
- Excellent communication skills to interact with healthcare providers, insurance companies, and patients
- Ability to work independently and meet deadlines in a fast-paced environment
- Knowledge of insurance claim submission procedures and reimbursement processes
Note: Certification in medical billing or coding is preferred but not required.
Job Type: Full-time
Pay: From $16.50 per hour
Expected hours: 36 per week
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Work Location: In person
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