Medical Biller

2 days ago

Ahmedabad, Gujarat, India OmniMD Full time

Profile - Medical Biller & Coder

Job Location

  • Ahmedabad (On-site)

Shift Time

  • US Shift (6:30 PM to 4:00 AM)

Scope of Work and Key Responsibilities :

A. Medical Coding Responsibilities

  • Review outpatient clinical documentation, superbills, and encounter forms to assign accurate
    CPT
    ,
    ICD-10-CM
    ,
    HCPCS Level II
    , and
    J codes
    .
  • Validate and calculate infusion and injection units based on
    dosage
    ,
    vial size
    , and
    HCPCS unit definitions
    .
  • Apply appropriate
    modifiers
     (25, 59, 76, 91, JW, JZ, etc.) based on procedure type and payer guidance.
  • Ensure compliance with
    CMS
    ,
    NCCI
    , and payer-specific billing rules.
  • Maintain up-to-date understanding of
    Medicare LCDs
    ,
    MUEs
    ,
    bundling/unbundling edits
    , and
    CCI policies
    .
  • Clarify any documentation discrepancies by coordinating directly with the provider or clinical team before claim submission.
  • Review rejected or denied claims to identify root causes and recommend corrective actions related to coding or documentation.
  • Support internal and external audits, ensuring all coded services are supported by clinical documentation.

B. Medical Billing Responsibilities

  • Prepare, verify, and submit
    claims
     through clearinghouses or directly to payers following payer-specific rules.
  • Review charges and ensure coding aligns with billed services and authorization requirements.
  • Post
    payments
    , reconcile
    EOBs (Explanation of Benefits)
    , and record adjustments accurately in the billing system.
  • Manage
    denials
     and
    rejections
    , correct identified errors, and resubmit claims promptly.
  • Track unpaid or underpaid claims and perform follow-up with payers to ensure timely reimbursement.
  • Handle
    patient billing inquiries
    , resolve statement issues, and explain balances when needed.
  • Monitor
    payer trends
    ,
    claim turnaround times
    , and
    aging reports
     to highlight revenue risks or systemic issues.
  • Collaborate with the coding, compliance, and operations teams to ensure end-to-end billing accuracy and revenue integrity.
  • Maintain accurate documentation of all billing actions and communications for audit readiness.

Compliance and Confidentiality

  • Adhere strictly to
    HIPAA
     and
    HITECH
     privacy and security requirements.
  • Ensure all activities comply with
    federal, state, and payer regulations
    .
  • Participate in compliance training and maintain awareness of coding and billing policy updates.

Performance and Quality Expectations

  • Maintain
    coding accuracy ≥ 95%
     and
    billing clean claim rate ≥ 98%
    .
  • Ensure all claims are submitted within agreed timelines.
  • Proactively identify and correct recurring claim or documentation issues.
  • Support continuous improvement of revenue cycle workflows and best practices.

Preferred Background and Skills

  • Minimum 2–3 years of experience in
    outpatient coding and billing
    .
  • Strong understanding of
    Medicare, Medicaid
    , and
    commercial payer
     rules.
  • Experience in
    Internal Medicine, Cardiology, Rheumatology, or Oncology
     preferred.
  • Familiarity with
    EHR and practice management systems
    .
  • Knowledge of
    revenue integrity
    ,
    audit processes
    , and
    drug wastage documentation
    .
  • Strong analytical, problem-solving, and communication skills.

Deliverables and Reporting

  • Daily: Charge review and claim submission logs.
  • Weekly: Denial and payment posting summary.
  • Monthly: Coding and billing accuracy reports, denial trends, and AR aging summary.
  • Periodic: Participation in compliance or internal audit reviews as assigned.

Benefits:-

· Friendly Environment

· Excellent Salary

· 5 Days Working

· Medical Insurance

. Accidental Insurance

· On-site Yoga, Gym, Sports, and Bhagwat Geeta Session

· Excellent Work-life balance

· Annual one-day Trip

. Fun-Friday Celebration

· All Festival Celebration

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