Medical Billing and Coding Specialist

Position Overview

The Medical Billing and Coding Specialist is responsible for ensuring accurate coding, billing, claim submission, payment posting, denial management, and reimbursement of healthcare services. This position serves as a key member of the revenue cycle team by ensuring compliance with payer regulations, maximizing reimbursement, and supporting financial sustainability while maintaining excellent customer service.

This position will report to the Chief Financial Officer.

Mission

To improve health and well-being, Allies provides integrated medical care, supportive human services, and community-based education for individuals living with, or at risk of HIV, viral hepatitis, and sexually transmitted infections.

Vision

Allies envisions a healthier community whereby people access integrated medical care and supportive human services in a respectful setting, free of stigma and discrimination.

Key Responsibilities

• Review clinical documentation for completeness and accuracy.
• Review and assign appropriate ICD-10-CM, CPT, HCPCS Level II, and modifier codes.
• Query providers when documentation requires clarification.
• Stay current on coding guidelines and payer requirements.
• Verify claim accuracy prior to submission.
• Correct rejected claims promptly.
• Monitor claim status through clearinghouses and payer portals.
• Work denials by solving, tracking and recommending process improvements.
• Correct coding or billing errors.
• Prepare appeals with supporting documentation.
• Track denial trends and recommend process improvements.
• Post insurance payments accurately.
• Post patient payments.
• Reconcile electronic remittance advice (ERA) and explanation of benefits (EOB).
• Identify payment variances and underpayments.
• Escalate contract discrepancies.
• Follow up on unpaid claims.
• Resolve aged receivables.
• Maintain assigned A/R work queues.
• Document payer communications.
• Answer billing questions.
• Explain insurance benefits and patient responsibility.
• Assist patients with payment arrangements.
• Coordinate with front office regarding registration and insurance issues.
• Maintain HIPAA compliance.
• Follow payer billing guidelines.
• Participate in internal audits.
• Report on potential compliance concerns.
• Collaborate with clinical teams to improve documentation.
• Participate in revenue cycle meetings

Organizational Expectations

• Seek out up-to-date information about Allies’ programs and services, as well as relevant local, regional, and national health statistics that will inform and support our Mission
• Improve job knowledge by remaining aware of new regulations and best practices; participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations
• Embrace and exemplify organizational standards and guiding principles for processes, protocols, and utilization
• Commit to Allies’ promise to sustain and extend diversity, equity, and inclusion
• Contribute to efforts which build and reinforce Allies’ distinctive, effective, and ethical practices

Requirements

Knowledge Skills and Abilities

• The Medical Billing and Coding Specialist should have demonstrated experience in the following areas: ICD-10-CM, CPT, HCPCS Level II, medical terminology, anatomy and physiology, insurance regulations, Medicare and Medicaid billing, commercial insurance billing, coordination of benefits, prior authorizations, appeals processes, HIPAA regulations.
• Additional required skills: excellent attention to detail, time management, strong analytical skills, problem-solving, customer service, written and verbal communication, Microsoft Office proficiency, EHR and billing software proficiency.

Preferred Qualifications

• Certification such as American Academy of Professional Coders: Certified Professional Coder (CPC), American Health Information Management Association: Certified Coding Specialist (CCS) or Certified Coding Associate (CCA) preferred.
• Athena EMR experience preferred.

A high school diploma is required, associate’s degree in health information management, Medical Billing, or a related field preferred. 2-3 years of medical billing and coding experience preferred.

The Medical Billing and Coding Specialist will be called upon to engage in physical activity appropriate to Clinic and Office environments including the capacity to stand or sit for extended periods. Current PA child abuse, PA criminal history, Federal criminal history clearances, and verification of TB test performed within the last year are required within the first 30 days of employment.

Salary for this position begins at $21/hr-$27/hr commensurate with relevant education, experience, and licensure. We comply with EEOC.