Medical Billing and Coding

• Review the complex (problematic coding that needs research and reference checking) medical records and accurately code the primary/secondary diagnoses and procedures using ICD-10-CM coding conventions • Review medical record documentation and accurately code the primary/secondary diagnoses using ICD-10-CM coding conventions • Sequence diagnoses using coding guidelines • Abstract and compile data from medical records for appropriate optimal reimbursement for Home Health or Hospice and/or professional charges • Consult with and educate physicians on coding practices and conventions to provide detailed coding information • Communicate with nursing and ancillary services personnel for needed documentation for accurate coding • Maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes and surgical techniques through participation in continuing education programs to effectively apply ICD-10-CM coding guidelines to inpatient and outpatient diagnoses and procedures • Maintain a thorough understanding of medical record practices, standards, regulations, The Joint Commission, Health Care/Finance Administration (HCFA), Medical Review of North Carolina (MRNC), DHHS (Department of Health and Human Service), etc. • Assist with special projects as required • Perform other related duties as assigned.

Medical Records Coder II

• Coordinate/review the work of subordinate employees and assist with the training and continuing education programs.
• Code medical records utilizing ICD-10-CM and CPT-4 coding conventions.
• Review the medical record to ensure specificity of diagnoses, procedures, and appropriate/optimal reimbursement for hospital and/or professional charges.
• Abstract information from medical records following established methods and procedures.
• Review the complex (problematic coding that needs research and reference checking) medical records and accurately code the primary/secondary diagnoses and procedures using ICD-10-CM and/or CPT coding conventions.
• Ensure quality and quantity of work performed through regular audits.
• Assist with research, development, and presentation of continuing education programs in areas of specialization.
• Sequence the diagnoses and procedures using coding guidelines.
• Ensure DRG/APC assignment is accurate.
• Abstract and compile data from medical records for appropriate optimal reimbursement for hospital and/or professional charges.
• Consult with and educate physicians on coding practices and conventions in order to provide detailed coding information.
• Communicate with nursing and ancillary services personnel for needed documentation for accurate coding.
• Maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes, and surgical techniques through participation in continuing education programs to effectively apply ICD-10-CM and CPT-4 coding guidelines to inpatient and outpatient diagnoses and procedures.
• Maintain a thorough understanding of medical record practices, standards, regulations, Joint Commission on Accreditation of Health Organizations (JCAHO), Health Care/Finance Administration (HCFA), Medical Review of North Carolina (MRNC), etc.
• Assist with special projects as required.
• Perform other related duties incidental to the work described herein.

Medical Records Coder II – Ophthalmology

• Evaluates medical records, provides clinical and surgical abstraction and assigns appropriate clinical diagnosis and procedure codes.
• Analyzes medical information from medical records
• Accurately codes diagnostic and procedural information in accordance with national coding guidelines
• Consults with medical providers to clarify missing or inadequate record information and to determine appropriate codes.
• Provides thorough, timely and accurate coding in accordance to department specific productivity and quality standards.

Profee Coder – Primary Care

• Ensure 100% charge capture by reviewing physician dictated notes and operative reports and properly code all services performed utilizing appropriate CPT, ICD-10-CM codes and modifiers.
• Daily review of EPIC Charge Review Work queues is essential.
• Monitor and report on accounts receivable issues related to payer compliance and/or billing processes.
• Act as a resource to providers, office staff, administration and the Central Business Office.
• Participation in coding training and education is also required.
• Maintain yearly certification as a Certified Professional Coder is required with the American Academy of Professional Coders.

Senior Billing Liaison, Coder

• Responsible for the billing team leadership, subject matter expertise, and organizing and performing a variety of regular tasks to ensure timely and comprehensive billing and collections for services rendered by NHC providers;
• Supervise and coordinate the workload of the billing staff to ensure all tasks are completed accurately and in a timely manner.
• Define and communicate current and new billing tasks and definitions of the billing team.
• Recommend and report billing issues of concern or accommodation to the clinic manager for action.
• Run, work, and manage reports for the purpose of verifying quality and completeness of various data entry and other functions in EPIC.
• Communicate with NHC staff about missing and erroneous data and ensure the completion and correction of the same.
• Work collaboratively with other members of the organization to maximize accuracy, efficiency, and promptness of the claim life cycle.
• Troubleshoot other problems in various billing processes and document to resolution problems discovered.
• Maintain and control documentation of billing processes.
• Execute quality control processes to ensure consistent billing and collection.
• Monitor third party coverage contracts, ensuring that current contractual terms are understood and applied correctly.
• Assist accounting with reconciling EPIC monthly deposit reports to the general ledger deposits.
• Assist CFO in completion of the annual cost reports, financial audit, annual UDS report, and any other required annual governmental reporting.
• Create and foster an environment that encourages professional growth of billing specialists.
• Other duties as assigned.
• Study and evaluate new and changing billing requirements and recommend solutions.
• Work directly with managers to revise processes and resolve issues.
• Document significant billing changes and methods for management awareness.
• Monitor changing standards and methods in billing to ensure NHC methods and processes are current.
• Manage and coordinate the billing team’s work results for quality, accuracy, and timeliness.
• Oversee and review the transmission of claims in EPIC as well as other electronic and paper claim processing.
• Follow up on unpaid claims within standard billing cycle timeframe.
• Oversee payment processing for accuracy and compliance.
• Provide customer service to patients enquiring about their accounts and process requests for refunds.
• Provide ongoing orientation and training to staff.

Medical Billing Manager

• Assign and sequence ICD-10-CM, ICD-10-PCS, and CPT-4 codes for inpatient, outpatient, ambulatory, and emergency room records while ensuring accuracy for billing, reimbursement, and compliance
• Review medical records for DRG/APC assignment, verify charge accuracy, abstract clinical data, and collaborate with providers and hospital departments to ensure proper documentation and regulatory compliance
• Accurately reflects the diagnosis and procedures per department procedure within the medical records
• Proactively communicates with providers, staff, leadership and hospital departments to ensure adequate documentation to support services
• Performs Charge capture and data entry per department protocol and procedure
• Ensures accurate abstracting of clinical data and meets regulatory and compliance requirements

Certified Facility Coder

• Answer client calls and follow up on interactions
• Prepare charges for offshore operations
• Create claim edit reports for charge entries
• Reconcile imputed payment postings and balances batch reports
• Audit charge and payment batches completed by offshore team

Medical Billing Coordinator

• Ability to comprehend medical record documentation to accurately assign codes for both concurrent and discharged accounts across multiple specialties.
• Meets minimum requirements for production and quality monthly.
• Requires a working knowledge of code sequencing for grouper-related payers with attention to detail to avoid rework and waste with charge capture assessment component.
• Requires understanding and application of M.E.A.T. criteria (i.e., monitoring, evaluation, assessment, treatment) using ICD 10 CM transaction data set to capture diagnoses.
• Analyzes high-risk encounters for accurate and/or missing charges gaps prior to encounter completion (i.e., missing charges from anesthesia, surgery) when manual charge capture occurs.
• Understand complexity of billing requirements and incorporates payer specific trends into day-to-day reviews to reduce “take backs” associated with unclear, or unsubstantiated care rendered. (i.e., varying modifier assignment for EAPG vs. Non-EAPG payer specificity)
• Requires excellent coding knowledge of ICD 10 CM, CPT 4, and modifier application, with expectations to maintain certification (i.e., CCS, CPC, RHIT, or RHIA) and apply ICD 10 CM Coding Guidelines specific to both inpatient and outpatient encounters.
• Facilitate modifications to clinical documentation through query interaction to ensure that the information captured supports the level of service rendered, with attention towards chronic conditions, hierarchical condition categories (HCC), and risk adjustment factors (RAF).
• Demonstrates an excellent working knowledge of hospital information systems to retrieve data specific information (i.e., order diagnosis, patient type) within a complicated filing schema including non-hospital data (i.e., Media Tab, Office Visits etc)

Outpatient Surgery Coder

• Prepare, review, and submit clean medical claims to commercial payers.
• Verify claim accuracy, including coding, modifiers, eligibility, EAP authorizations, and provider details
• Monitor claim rejections and take timely corrective actions
• Manage denial resolution: research root cause, correct and resubmit, or prepare appeals
• Conduct proactive follow-up on outstanding A/R and aging claims
• Support patient billing activities and inquiries when needed
• Document all billing activities clearly and accurately in internal systems
• Ensure compliance with HIPAA, payer regulations, and state/federal billing guidelines
• Collaborate with credentialing, eligibility/benefits, clinical operations, and internal RCM teammates
• Identify trends and recommend process improvements to reduce denials and rework

Medical Billing Specialist

• Execute tasks focused on revenue generation through account resolution for any company client.
• Review documentation to support or contest payer coding decisions for multiple facilities.
• Prepare clear, concise, and well-supported appeals where applicable, using all available documentation, coding guidelines, and regulatory references to defend billed claims and secure reimbursement on insurance accounts receivable.
• Investigate the root causes of denials and downgrades, as needed.
• Provide targeted training on coding practices to Currance team members, promoting accuracy, compliance, and efficiency in resolving coding-related issues.
• Participate in daily shift briefings and contribute actively.
• Resubmit corrected claims according to Federal, State, and payer-mandated guidelines.
• Research, analyze, and correct claim errors and rejections to ensure accurate resubmission and to avoid payer denials due to preventable errors.
• Escalate problematic accounts, recurring issues, or trends to Supervisor and recommend education or denial prevention measures to the client.
• Stay current on payer updates, process changes, and coding guidelines to maintain compliance with Federal, State, and payer requirements.
• Meet productivity standards while maintaining quality output.
• Communicate payer-specific issues to the team and management for timely resolution.
• Engage in continuous learning to remain up to date on coding and payer policies.

Denial Resolution Specialist

• Performs HCC coding on projects for MA, ACA, and End Stage Renal Disease (ESRD)
• Works independently in various coding applications
• Adheres to CMS Guidelines for Coding and Highmark’s Policy and Procedures
• Maintains RPM coding accuracy and productivity requirements
• Assists with Regulatory Audits by performing first coding review

HCC Coding Specialist

• Accurately assigns appropriate ICD-10-CM and CPT-4 codes to outpatient records
• Abstract essential data elements for tracking, reporting, and reimbursement purposes
• Keying, billing and collections for assigned client databases
• Review and analyze medical records for document deficiencies
• Ensure accurate coding and compliance with Federal and State regulations
• Verify accuracy of patient account, type, and demographic data
• Meet productivity standards set by Revenue Integrity Coding department

Certified Professional Coder

• Reviews complex inpatient documentation at a highly skilled and proficient level to assign diagnosis and procedure codes utilizing ICD-10 CM/PCS, CPT, and HCPCS
• Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations utilizing an EMR and/or Computer Assisted Coding software
• Responsible for coding high dollar and long length of stay cases for all patient types
• Serves as a subject matter expert to Coding department leaders and peers
• Recommends modifications to current policies and procedures as needed to coincide with government regulations
• Collaborates with the Clinical Documentation Improvement and Quality teams to ensure a match in the DRG and reconciles each Medicare case from a CDI perspective
• Responsible for clinician communication related to disease processes on a clinical level to ensure accurate coding
• Participates in payer audits and meetings by acting as a resource for coding-related audits, as requested

Inpatient Coder Specialist – Community Facility

• Accurately assigns diagnosis and procedure codes for inpatient facility and professional services.
• Performs necessary tasks within MHS GENESIS and other military coding systems.
• Accurately assign Evaluation and Management (E&M) codes, ICD-CM diagnoses, CPT and HCPCS, modifiers, and quantities derived from medical record documentation.
• Reviews encounter and/or record documentation to identify and resolve inconsistencies, ambiguities, or discrepancies.
• Assigns accurate codes based on provider responses to coding queries.
• Supports DHA coding compliance by performing due diligence in ethically and appropriately researching and/or interpreting existing guidance.
• Utilizes MHS computer systems to remotely access patient records and assign codes for patient encounters in support of other MTFs.
• Achieve and maintain DHA coding productivity and accuracy standards for the position.
• Educates and provides feedback to providers and clinical staff to resolve documentation issues to support coding compliance.
• Acts as a source of reference to medical staff having questions, issues, or concerns related to coding.
• Responds to provider questions and provides examples of appropriate coding and documentation reference(s).

Medical Coder II

• Coordinate/review the work of subordinate employees and assist with the training and continuing education programs.
• Code medical records utilizing ICD-10-CM and CPT-4 coding conventions.
• Review the medical record to assure specificity of diagnoses, procedures, and appropriate/optimal reimbursement for hospital and/or professional charges.
• Abstract information from medical records following established methods and procedures.
• Review the complex medical records and accurately code the primary/secondary diagnoses and procedures using ICD-10-CM and/or CPT coding conventions.
• Ensure quality and quantity of work performed through regular audits.
• Assist with research, development, and presentation of continuing education programs on areas of specialization.
• Maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes, and surgical techniques through participation in continuing education programs.

Medical Records Coder II – Outpatient

• Review medical records for documentation accuracy and assign the correct CPT and ICD-10 codes to the claim
• Conduct or assign audit reviews of coding and procedures specification
• Perform and oversee all billing processes, including primary/secondary and rebilling, including necessary claim edits on both internal and external software systems
• Check clearinghouse transmission daily to ensure files are successfully transmitted to the intermediary
• Handle follow up on billed patient accounts to successfully collect owed balances
• Post payments as required via cash, credit cards, EFT and third-party vendors, etc.
• Review and adjudicate EOBs/RAs to determine if the Surgery Center was paid correctly by the payer
• Deal with denials in an efficient and effective manner, handling appeals as needed to get claims paid
• Remain actively involved in KPIs associated with the financial performance of the Surgery Center

Medical Billing & Collection Specialist – Part-Time

• Billing Data Entry involved which requires 10 key skills
• Compare data with source documents and enter billing information provided
• Research missing or incorrect information
• Verification of insurance information
• Ensure daily/weekly billing activities are completed accurately and timely
• Research and update billing demographic data to ensure prompt payment from insurance
• Communication through phone calls with clients and patients to resolve billing defects

Billing Coordinator I – Healthcare Billing Specialist

• Reviews and interprets medical information, physician treatment plans, course, and outcome to determine appropriate ICD-10 CM/CPT codes for diagnoses and procedures. ( 65%)
• Abstracts data elements to satisfy statistical requests by the hospital, health system, medical staff, etc. and enters all coded/abstracted information into designated system. ( 15%)
• Ensures efficient management of medical information and cash flow as it pertains to the unbilled coding report. ( 10%)
• Keeps informed of the changes/updates in ICD-10 CM/CPT guidelines by attending appropriate training, reviewing coding clinics and other resources and implementing these updates in daily work. ( 5%)
• Performs other duties as assigned or required. (5%)

Coder – Outpatient

• Responsible for reviewing and abstracting inpatient medical records
• Identifying and assigning accurate medical codes for diagnosis, procedures, and services in an inpatient setting
• Ensuring all data elements required for federal or state reporting and billing are collected
• Reviews medical record documentation to identify pertinent diagnosis/procedures for inpatient records
• Queries physicians when code assignments are not straightforward or documentation is inadequate
• Keeps abreast of coding guidelines and reimbursement reporting guidelines
• Effectively assigns ICD-10 codes and DRGs to inpatient records
• Maintains 92% to 95% in ICD-10 and DRG assignment and consistently meets established productivity standards

Senior Certified Inpatient Coding Specialist

• Independently perform complex, specialty-specific professional fee coding (CPT/HCPCS and ICD-10-CM) for physician services rendered in both office and hospital settings
• Ensure all coding adheres strictly to official guidelines (e.g., provided by AAPC or AHIMA), federal regulations (CMS), and organizational compliance standards
• Identify the need for formal clinical queries for documentation clarification when necessary for professional or facility records
• Maintain high accuracy and productivity standards appropriate to the complexity of the assigned workload
• May provide informal guidance to new coding staff on professional coding nuances

Medical Billing and Coding jobs in North Carolina

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