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Medical Billing, Coding and Denial Specialist
MicroHealthExperienced Medical Billing, Coding, and Denial Specialist with a focus on hospital services. Overseeing coding compliance and claims processing for inpatient and outpatient services in a remote setting.
About the role
Key responsibilities & impact- Assign accurate and compliant ICD-10-CM diagnosis codes for inpatient encounters
- Assign accurate and compliant ICD-10-PCS procedure codes
- Review physician documentation for completeness and accuracy
- Identify complications and comorbidities to ensure appropriate DRG assignment
- Query physicians for documentation clarification when necessary
- Ensure compliance with all applicable coding guidelines
- Assign accurate CPT/HCPCS codes for outpatient services
- Review encounter/charge data for completeness prior to claim submission
- Prepare UB-04/837I institutional claims and CMS-1500/837P professional claims
- Validate all coding assignments and charges against documentation
- Submit claims electronically through designated clearinghouse or billing system
- Monitor claim acceptance or rejection status
- Review and analyze claim denials and rejections
- Track denial trends and recommend process improvements
- Maintain 95% patient billing accuracy rate
- Document all coding decisions, queries, and claim corrections
- Collaborate with clinical documentation improvement staff
Requirements
What you’ll need- Minimum 10 years of hospital medical billing and coding experience
- 5+ years of demonstrated experience in supervisory role of hospital setting highly desirable
- Extensive experience with Emergency Room (ER) medical billing and coding
- Required system experience with one or more of the following: CareVue, VistA, CPRS
- Familiarity with hospital billing systems and clearinghouses
- Electronic claims submission experience
- Active certification as CPC or CCS preferred
- Comprehensive knowledge of Medicare and Medicaid billing requirements
- Proficiency in ICD-10-CM diagnosis and procedure coding
- Proficiency in CPT/HCPCS coding
- Experience with UB-04/837I institutional claim formats & CMS-1500/837P professional claim formats
- Knowledge of APC assignment
Benefits
Comp & perks- Comprehensive and competitive benefits package
ATS Keywords
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Hard Skills & Tools
ICD-10-CM codingICD-10-PCS codingCPT codingHCPCS codingUB-04 claim format837I claim formatCMS-1500 claim formatelectronic claims submissionmedical billingcoding compliance
Soft Skills
attention to detailcommunicationcollaborationproblem-solvingsupervisory skillsanalytical skillsdocumentationprocess improvementaccuracyquerying
Certifications
CPCCCS