Coding Specialist

What You’ll Do (Key Responsibilities)

• Clinical Coding & Charge Entry (35% of your time)
  • Assign and sequence appropriate ICD-10-CM diagnosis codes and CPT/HCPCS procedure codes based on clinical documentation.
  • Translate patient transport data into billable charges, ensuring that the level of service billed perfectly matches the medical necessity documented in the Electronic Patient Care Report (ePCR).
  • Maintain a sharp, up-to-date understanding of coding bundling, modifiers, and global periods to proactively prevent claim denials.
• Demographic & Insurance Verification (25% of your time)
  • Conduct comprehensive audits of patient information, including legal name, address, date of birth, and guarantor details for every claim.
  • Verify insurance eligibility and primary/secondary/tertiary coverage using clearinghouses and payer portals.
  • Ensure all insurance details are entered flawlessly to minimize "front-end" rejections.
• Documentation Compliance & "Send Backs" (20% of your time)
  • Review ePCRs for signature compliance and missing clinical documentation.
  • Identify and flag incomplete records, preparing "send back" tasks for clinical staff or providers to ensure documentation meets legal and billing guidelines.
  • Monitor the "Send Back" queue to ensure corrections are returned and processed quickly.
• Claims Resolution & Rebilling (15% of your time)
  • Research and resolve basic claim edits or denials related to coding or demographic discrepancies.
  • Update account notes to accurately reflect the status of rebilled claims and any actions taken to resolve payment delays.
• Systems Maintenance & Team Collaboration (5% of your time)
  • Perform critical data corrections within HealthEMS and other ePCR programs.
  • Cookordinate with providers, clients, and internal colleagues via email and Slack to resolve billing hurdles.
  • Stay current on company processes and industry regulatory updates by actively participating in department meetings.

What We’re Looking For

• Experience: At least 3 years of experience with Medical Insurance.
• Knowledge, Skills, & Abilities:
  • Technical Knowledge: Proficiency in ICD-10-CM coding; familiarity with CMS (Medicare/Medicaid) billing rules, private payer regulations, and medical necessity for emergency/non-emergency transport.
  • Core Skills: High-speed, high-accuracy data entry; advanced problem-solving; professional written communication; ability to interpret complex medical narratives.
  • Key Abilities: A strong ability to maintain deep focus and accuracy during repetitive tasks, and the organizational skill to manage multiple "queues" or task lists simultaneously.