Medical Coding Specialist

A key member of our revenue cycle management team, the Certified CPC Coder plays a critical role in ensuring accurate coding and billing for diagnostic imaging studies. Our organization requires a detail-oriented professional to analyze radiology reports, maintain high-quality standards, and ensure compliance with regulatory requirements.

• This challenging position offers excellent growth opportunities within our expanding RCM division and the chance to work with cutting-edge healthcare technology.

• Code Review & Validation: Review and reconcile CPT, ICD-10, and HCPCS codes for radiology studies to ensure 99%+ accuracy rates.
• Documentation Analysis: Analyze radiology reports and ensure proper coding compliance with CMS guidelines and payer-specific requirements.
• Quality Assurance: Conduct regular audits of coded studies to maintain high-quality standards and identify areas for improvement.
• Regulatory Compliance: Ensure adherence to HIPAA, CMS regulations, and facility-specific billing protocols.

• Invoice Management: Prepare, compile, and submit accurate invoices to partner healthcare facilities based on contracted fee schedules.
• Reconciliation: Validate invoice line items against study volumes, modality types, and applicable reimbursement rates.
• Payment Tracking: Monitor invoice submission status, follow up on approvals, and track payment receipts through completion.
• Collections Support: Assist in resolving payment delays, rejected claims, and coding-related billing issues.

• Cross-functional Coordination: Work closely with radiologists, technologists, and operations teams to resolve coding discrepancies and missing documentation.
• Stakeholder Management: Communicate effectively with facility billing departments and insurance representatives.
• Issue Resolution: Escalate and resolve complex billing issues including underpayments, denials, and coding appeals.

• Performance Metrics: Generate comprehensive reports on coding accuracy, invoice status, aging analysis, and collection metrics.
• Data Management: Maintain detailed billing logs, reconciliation spreadsheets, and monthly facility billing records.
• Process Improvement: Identify opportunities to streamline billing processes and improve revenue cycle efficiency.

Required Qualifications:

• Bachelor's degree in Accounting, Finance, Business Administration, Healthcare Administration, or related field.
• CPC Certification from AAPC (American Academy of Professional Coders) - Required.
• Additional certifications in radiology coding (CPC-A, CIRCC) - Preferred.

Professional Experience:

• Minimum 3 years of hands-on experience in US medical billing and coding.
• Radiology billing experience strongly preferred (CT, MRI, X-ray, Ultrasound, Nuclear Medicine).
• Proven track record of maintaining high coding accuracy (95%+ preferred).
• Experience with denial management and appeals processes.

Technical Skills:

• Advanced proficiency in Microsoft Excel (VLOOKUP, pivot tables, macros, advanced formulas).
• Billing Software Experience: Proficiency with RCM platforms such as Kareo, AdvancedMD, eClinicalWorks, Epic, Cerner, or similar systems.
• EDI Knowledge: Understanding of electronic data interchange formats (837P, 837I, 835, 277, 276).
• Database Management: Experience with SQL queries and database management - Preferred.

Core Competencies:

• Analytical Excellence: Strong problem-solving skills with attention to detail and accuracy.
• Communication Skills: Excellent written and verbal English communication abilities.
• Time Management: Ability to manage multiple priorities and meet tight deadlines.
• Independence: Self-motivated with ability to work autonomously across different time zones.
• Adaptability: Flexibility to adapt to changing healthcare regulations and billing requirements.