Medical Billing & Coding Specialist

Access Group - Dearborn, MI

Full-time - Entry Level

Dearborn, MI

Religious, Grantmaking, Civic, Professional, and Similar Organizations

About the position

The Medical Billing and Coding Specialist is responsible for processing health insurance claims for services provided at clinics. This role involves submitting claims for reimbursement, coaching healthcare providers for optimal reimbursements, and ensuring compliance with relevant coding guidelines.

Responsibilities

• Verify the provider's determination of services provided and patient diagnoses via office and operative notes.
• Enter charges in the billing system and/or review them.
• Maintain complete knowledge and comply with all relevant insurance, CPT coding, and diagnosis guidelines, disseminating information to staff and providers as necessary.
• Review quarterly provider audits, researching proper coding when necessary and working with coding and compliance as needed.
• Create relationships with external organizations to streamline and resolve billing matters for patients.
• Document conversations with insurance companies and patients.
• Audit agency reports for procedures with office billing to ensure accuracy of billing to payers.
• Audit EMR entries to verify correct insurance and demographic information.
• Attend regularly scheduled meetings.
• Coordinate and follow through with special projects as assigned.
• Create a positive, professional, service-oriented work environment for staff, clients, and family members by supporting the ACCESS mission and core values statement.
• Use a special coding system to choose diagnosis and procedure codes.
• Enter the correct codes into patients' electronic health records.
• Review claims to ensure coding accuracy.
• Work with other staff members to ensure accuracy.
• Enter insurance claims into specialized billing programs.
• Interact with patients to clarify insurance matters.
• Follow up with insurers about any late payments.
• Track payments to ensure reimbursements are received on time.
• Keep in tune with changes and advancements in the field.
• May be responsible for credentialing.
• Operate standard office equipment and use required software applications.
• Perform other duties and responsibilities as assigned.

Requirements

• Associate degree required; Bachelor's degree preferred.
• At least 3-5 years previous clinical billing experience or equivalent combination of education, experience, and/or training approved by Human Resources.
• Medical Billing and Coding Certificate or Degree in the field, Certified Professional Coder (CPC), Nationally Registered Certified Coding Specialist (NRCCS), or Registered Health Information Technician (RHIT) required.

Nice-to-haves

• Experience with Windows operating systems.
• Strong customer service skills.
• Critical thinking and problem-solving skills.

Benefits

• Health insurance coverage.
• Paid time off for holidays and vacations.