Medical Billing Specialist- Certified Coder

Job Description

We are seeking a detail-oriented and experienced Certified Medical Coder & Biller to join our team. The ideal candidate will have 2–4 years of hands-on medical coding and billing experience, with a strong understanding of CPT and ICD-10 coding guidelines. This individual must be a self-starter who can work independently with minimal supervision while maintaining accuracy and compliance with all regulatory requirements, including government payer guidelines.

• Review and accurately assign CPT, ICD-10, and HCPCS codes to medical procedures and diagnoses.
• Ensure coding accuracy and compliance with federal, state, and payer-specific regulations, including Medicare and Medi-Cal guidelines.
• Submit claims to insurance carriers, including government payers, in a timely and accurate manner.
• Apply proper coding rules specific to Medicare and Medi-Cal claims, including NCCI edits and medical necessity requirements.
• Review and resolve claim edits, rejections, and denials, with a strong focus on government payer denials.
• Perform corrections and rebill claims as necessary.
• Verify documentation supports billed services and coding selections.
• Work closely with providers and clinical staff to clarify diagnoses and procedures.
• Maintain detailed and compliant documentation within the billing system.
• Monitor accounts receivable and follow up on outstanding claims as needed.
• Stay up to date with coding updates, payer policies, including CMS and Medi-Cal regulations.

Qualifications

• Certification: Certified Professional Coder (CPC) through AAPC OR equivalent certification (e.g., CCS, CCA).
• Experience: 2–4 years of medical coding and billing experience required.
• Skills: Hands-on experience billing and coding for Medicare and Medi-Cal claims, including understanding of payer-specific rules and reimbursement structures; experience working claim edits, denials, and payer follow-up.

Technical Skills

• Experience with EHR/EMR systems; familiarity with Allscripts is a plus.
• Strong knowledge of billing workflows and revenue cycle processes.
• Proficient in Microsoft Office, especially Excel.

Skills And Abilities

• Strong attention to detail and accuracy.
• Ability to work independently with minimal supervision.
• Excellent problem-solving and analytical skills.
• Strong organizational and time management abilities.
• Effective communication skills, both written and verbal.
• Ability to manage productivity and meet daily/weekly coding and billing targets.
• Maintain compliance with HIPAA and company policies.
• Collaborate with cross-functional teams while maintaining accountability for individual workload.

Company Requirements

• Must be able to pass a pre-employment drug test, physical, and a background check to include a 7-year criminal, 10-year SSN & employer history reference check.
• Must be able to provide proof of COVID-19 vaccination on the first day of work.
• Excellent interpersonal skills.
• Attention to detail.
• Must be able to work flexible schedules.
• Must take yearly flu shot or wear flu mask during flu season for patient-facing positions and test for tuberculosis as required by the Centers for Disease Control and Prevention.

Benefits

• Medical, Dental, Vision, Life and LTD insurance (may be eligible on the 1st of the month following date of hire).
• 12 Paid Holidays (including 1 mental health day).
• 401(k) Retirement plan (may be eligible for employer matching up to 4% following completion of 90th day of employment).
• Flexible Spending Account (FSA).
• 40 hours of sick pay (following completion of 90th day of employment).
• 120 hours of PTO accrued within the 1st year of employment.