Billing and Coding Specialist

About the Role

The Coding Specialist supports the organization by ensuring accurate, compliant, and optimized medical coding. This role serves as a subject matter expert in coding guidelines, documentation requirements, payer policies, and regulatory compliance. The Coding Specialist works closely with providers, clinical staff, billing personnel, and office leadership to improve documentation integrity, coding accuracy, clean claim submission, and overall revenue cycle performance. The role also focuses on adopting and optimizing new technologies, including AI-enabled coding tools and workflow automation, to enhance efficiency, accuracy, consistency, and scalability within the revenue cycle.

Responsibilities

• Encourages, motivates, and models engagement in assigned responsibilities in alignment with the organization’s mission.
• Supports a positive patient experience by ensuring coding accuracy and appropriate billing outcomes; assists with resolving patient and payer questions related to coding.
• Reviews provider documentation and accurately assigns appropriate diagnosis, CPT, and HCPCS codes in compliance with regulatory requirements, payer policies, and organizational guidelines.
• Identifies coding errors, inconsistencies, missing documentation, and opportunities for improvement through routine coding reviews.
• Supports the implementation and optimization of AI-assisted coding tools, automation platforms, and other technologies to improve coding accuracy and efficiency.
• Evaluates workflows and serves as a resource to team members during technology implementation.
• Works closely with providers and clinical teams to improve the accuracy, completeness, and consistency of clinical documentation; provides education and feedback on documentation requirements.
• Reviews coding-related claim denials, identifies trends and root causes, and recommends corrective actions in collaboration with billing staff.
• Participates in internal and external coding audits and assists with audit responses and corrective action plans.
• Maintains current knowledge of payer-specific coding requirements, authorization requirements, regulatory changes, and applicable coding guidelines; communicates important changes to team members.
• Collaborates with colleagues, billing staff, providers, and clinical teams to ensure alignment between coding, billing, documentation, and authorization processes.
• Serves as a resource for coding staff and providers regarding complex coding questions, documentation requirements, payer policies, and appropriate code selection.
• Provides coding education, coaching, and ongoing support to clinical and administrative team members; identifies training opportunities based on errors, denials, audits, and regulatory changes.
• Maintains current knowledge of coding guidelines, payer policies, regulatory requirements, industry best practices, and emerging coding technologies; participates in continuing education.
• Identifies opportunities to improve coding workflows, reduce manual processes, increase first-pass claim accuracy, and enhance revenue cycle efficiency.
• Monitors coding accuracy, denial trends, documentation issues, and other relevant metrics; communicates findings and recommendations to leadership.
• Assists with revenue cycle initiatives, system implementations, audits, workflow redesign, technology implementation, and other special projects as assigned.
• Performs other related duties and responsibilities as required.