Billing & Coding Specialist

Job Description:

Work Timings: 7:30 PM - 4:30 AM IST
Working Days: 5 Days a Week

Job Summary

We are seeking a detail-oriented and compliance-driven Medical Billing & Coding Specialist to manage end-to-end medical billing operations, including accurate coding, claims submission, payment posting, denial management, and accounts receivable follow-ups. The role requires strong knowledge of US healthcare billing regulations, insurance processes, and EHR systems to ensure timely and accurate reimbursement.

Key Responsibilities

Medical Coding & Documentation
Assign accurate CPT, ICD-10, and HCPCS codes to diagnoses, procedures, and services rendered.
Review medical records and clinical documentation to ensure billed services align with documented procedures and diagnoses.
Ensure coding accuracy and compliance with payer-specific and regulatory guidelines.
Insurance Verification & Billing
Verify patient insurance eligibility, benefits coverage, and billing requirements before claims submission.
Determine appropriate billing methods based on insurance plans and coverage details.
Generate and submit electronic or paper claims to insurance companies and government payers within defined timelines.
Claims Management & Follow-Up
Monitor submitted claims for status updates, denials, and rejections.
Perform follow-ups with insurance companies to resolve claim issues and ensure timely reimbursement.
Identify root causes of denials and initiate corrective actions.
Payment Posting & Patient Billing
Accurately post payments received from insurance companies, patients, and third-party payers.
Reconcile payments with claims and update patient accounts accordingly.
Generate patient statements for balances not covered by insurance and respond to patient billing inquiries.
Appeals & Accounts Receivable
Prepare and submit appeals for denied or underpaid claims with appropriate supporting documentation.
Review and manage Accounts Receivable (AR) aging reports to identify overdue or unpaid claims.
Initiate collection actions and follow-ups to reduce AR days.
Compliance & Record Management
Ensure adherence to billing regulations, payer guidelines, and ethical coding standards.
Maintain accurate and organized billing records, correspondence, coding references, and payment documentation.
Reporting & Communication
Prepare and share reports on billing performance, claim status, denial trends, and payment metrics.
Maintain effective communication with providers, medical staff, insurance companies, patients, and internal teams to resolve billing-related issues.
Systems & Collaboration
Utilize medical billing software and EHR systems efficiently to manage billing workflows.
Collaborate with coders, clinicians, administrative teams, and finance teams to ensure billing accuracy.
Assist in training new team members on billing processes, coding standards, and system usage.
Continuous Improvement
Stay updated on changes in medical coding guidelines, billing regulations, and industry best practices.
Participate in process improvements to enhance billing efficiency and compliance.

Required Skills & Qualifications

Proven experience in US Medical Billing & Coding.
Strong knowledge of CPT, ICD-10, HCPCS, and insurance billing guidelines.
Experience with EHR/EMR and medical billing software.
Familiarity with claims submission, denial management, and AR follow-ups.
High attention to detail and accuracy.
Strong communication and coordination skills.
Ability to work independently in a remote, night-shift environment.