Abrar Admin

Empowerment Resource Center

<p></p><div><div><b>Job Classification: Billing &amp; Coding Specialist</b></div><div><b>
Reports To: Client Services Supervisor</b></div><div><b>
FLSA Status: Part -Time not to Exceed 29 Hours week</b></div><div></div><div><b><br>
Summary: </b>Reports to the Client Services Supervisor. The Billing &amp; Coding Specialist is responsible for managing the end-to-end medical billing process, including claim submission, payment posting, denial resolution, and reconciliation across EMR and QuickBooks systems and payer compliance to ensure timely and accurate revenue collection for the organization. . This position ensures compliance with payer contracts and coding standards, promotes accurate reimbursements, and supports financial transparency. The role plays a vital part in maintaining the organization&rsquo;s financial health, improving cash flow, and ensuring alignment with private insurance carrier agreements.</div><div></div><div><br>
The Billing &amp; Coding Specialist must have a strong understating of CPT, ICD-10 and insurance billing codes, as well as, working knowledge of payer contracts, private carrier reimbursement methodologies, and compliance requirements, The incumbent ensures that all claims are processed correctly, reimbursement are maximized, and revenue is maintained through careful monitoring, auditing, and collaboration with internal departments and payers. The role supports and enhances the insurance billing function through diligent claim management, payer communication, and reconciliation activities that promote accurate reimbursement and financial transparency.</div><div></div><div><b><br>
Essential Duties and Responsibilities:</b></div><div></div><h1 class="jobSectionHeader"><b><br>
Insurance Claims Management</b></h1><div><ul><li>
Verify CPT codes prior to claim submission in the EMR system to ensure compliance and maximize reimbursement.</li><li>
Collaborate with coding and revenue cycle teams to resolve complex CPT coding issues beyond standard expertise.</li><li>
Prepare, review, and submit insurance claims through the EMR system, ensuring compliance with payer-specific and contractual requirements.</li><li>
Monitor and manage claim submissions to ensure accuracy, timely filing, and proper follow-up on rejections or denials.</li><li>
Research claim denials and rejections, determine root causes, and take corrective actions to resolve issues promptly.</li><li>
Revise and resubmit corrected claims with necessary documentation and coding updates to secure proper reimbursement.</li><li>
Participate in weekly meetings with clinic leadership to analyze denials, rejections, and claim status for continuous improvement.</li><li>
Monitor the adjudication of submitted claims to verify timely processing, accuracy, and alignment with contracted reimbursement rates.</li><li>
Represent and advocate for corrected or underpaid claims during follow-up with insurance carriers.</li><li>
Ensure all billing activities comply with payer contracts, including fee schedules, covered services, and filing deadlines established by private carriers.</li></ul><p>
Payment Processing</p><div><ul><li>
Post all insurance payments&mdash;checks, ACH, and virtual card payments&mdash;into the EMR system, ensuring proper allocation to patient accounts.</li><li>
Collaborate with Accounts Receivable (A/R) to review outstanding claims, address aged accounts (91+ and 121+ days), and ensure all posted payments are reflected accurately.</li><li>
Track unpaid claims, follow up with insurance companies, and execute collection procedures on delinquent accounts to minimize write-offs.</li><li>
Pull and review A/R reports regularly to identify trends, payment delays, or discrepancies</li></ul></div><p>
Contract Compliance and Payer Relations</p><div><ul><li>
Maintain up-to-date knowledge of payer contracts, reimbursement terms, and policy changes for private carriers.  Verify that all claims, payments, and adjustments adhere to negotiated fee schedules and contractual obligations.</li><li>
Identify and report patterns of underpayment or contract violations by payers to management.</li><li>
Assist leadership with payer audits, renegotiations, and periodic reviews to ensure continued compliance and optimal reimbursement.</li><li>
Serve as a liaison between the organization and private insurance carriers to promote positive working relationships and resolve contract-related billing concerns.</li><li>
Participate in regular meetings with A/R and billing support teams to align on claim status, outdated accounts, and reconciliation needs.</li><li>
Communicate professionally with insurance representatives, patients, and internal teams to facilitate timely resolutions and optimize reimbursement workflows.</li></ul></div><p><b>
Qualifications: </b>To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</p><div><ul><li><b>
Education and/or Experience: </b>High school diploma or equivalent required; Associate&rsquo;s or Bachelor&rsquo;s degree in Healthcare Administration, Accounting, or related field preferred. 2+ years of experience in medical billing, insurance claims, or accounts receivable management required. Proficiency in EMR systems. Strong understanding of CPT, ICD-10, and insurance billing codes (certified coder preferred but not required). Working knowledge of payer contracts, private carrier reimbursement methodologies, and compliance requirements. Excellent organizational, analytical, and problem-solving skills. Strong communication skills and attention to detail.</li><li><b>
Certifications, Licenses, Registrations: </b>Certified coder preferred, but not required.</li><li><b>
Language Skills:</b> Fluency in English and Spanish is preferred. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, participants, funders, and the general public.</li><li><b>
Computer Skills: </b>Must possess extensive computer skills and experience with software use (Word, Excel, PowerPoint, Publisher, Adobe, etc.). Must be proficient in Microsoft Office Suite; Electronic mail software; Microsoft Exchange. Medical software &ndash; Electronic medical/health records software and Client management software. Helpful if you have experience in Greenway, and any Telemedicine platform. Knowledge of Quest and LabCorp systems.</li><li><b>
Mathematical Skills: </b>Basic math, bookkeeping and accounting skills.</li><li><b>
Reasoning Ability: </b>Effective computer skills to use bookkeeping and account management software in a timely and efficient manner. Strong communication, including writing, speaking and active listening. Must be a great communicator, meticulous, and possess excellent interpersonal skills. Great customer service skills, including interpersonal conversation, patience and empathy. Good problem-solving and critical thinking skills. Organization, time management and prioritization abilities. Ability to be discreet and maintain the security of patient or customer information. Understanding of industry-specific policies, such as HIPAA regulations for health care. Demonstrate the ability to exercise discretion, independent judgment, and business acumen. Exhibit the finesse to handle private, confidential, protected, and sensitive information. Possess a genuine empathy for clients and a willingness to help others. Possess excellent communication skills and the tact to deal effectively with clients, guests, program staff, medical and behavioral health professionals, and executive-level staff. Must have the ability to interact with professional staff and clients from diverse socioeconomic background, races, and cultures. Must have the ability to conduct Internet research. Must possess strong leadership, team-building, management, organizational, and time management skills. Must possess the ability to develop innovative action plans to improve efficiency and processes, minimize cost/waste, and meet quality standards.</li></ul></div></div><p></p><div><p><b><br>
Employment Standards &amp; Conditions: </b>Must successfully pass a pre-employment drug screen and background check.</p><p>
Must be able to work flexible hours when required.</p><p>
Must submit verification of completion of the following current health screenings:</p><p>
Influenza immunization</p><p>
Tuberculin Skin Test (TB) within the past 12 months</p><p>
HBV immunization (required if position requires direct contact with clients)</p><p></p><p><b><br>
Physical Demands: </b>The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</p><p>
While performing the duties of this job, the employee is regularly required to talk and hear.</p><p>
The employee is regularly required to sit, stand and walk.</p><p>
The employee s regularly required to use hands to key, handle, or feel and reach with hands and arms.</p><p>
The employee must occasionally lift and/or move up to 25 pounds.</p><p></p><p><b><br>
Work Environment: </b>The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is moderate.</p><p><i>
Empowerment Resource Center (ERC) values a diverse, respectful, and collaborative work environment. We establish and maintain trustful relationships with our staff, partners, funders, and the communities that we are privileged to serve. ERC makes all hiring and employment decisions without regard to race, creed, color, age, gender, gender identity, marital or parental status, religion, ancestry, national origin, physical or mental disability, sexual orientation, sexual identity, immigrant status, political affiliation or belief, exoffender status (depending on the offense and position to be filled), and/or unfavorable military discharge.</i></p></div></div><p></p>

Billing & Coding Specialist

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Billing & Coding Specialist