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Medical Billing and Coding Admin
Position Summary
The Medical Billing & Coding Administrator is responsible for accurate medical coding, claims submission, payment posting, denial management, and revenue cycle support for medical clinic and healthcare operations. This role ensures compliance with federal, state, payer, and company billing regulations while supporting timely reimbursement and clean claim submission.
The position works closely with providers, front desk staff, clinical teams, insurance companies, and clearinghouses to ensure proper documentation, coding accuracy, and revenue integrity.
Essential Duties & Responsibilities
- Review provider documentation for accuracy and completeness
- Assign appropriate ICD-10, CPT, and HCPCS codes
- Ensure coding complies with payer and regulatory requirements
- Identify documentation deficiencies and follow up with providers
Billing & Claims Management
- Prepare and submit electronic insurance claims
- Review claims for billing accuracy before submission
- Monitor claim status and payment processing
- Resolve claim rejections and denials
- Submit corrected claims and appeals as needed
Revenue Cycle Management
- Post insurance and patient payments accurately
- Reconcile accounts receivable balances
- Follow up on outstanding claims and unpaid balances
- Work aging reports and denial reports
- Assist with insurance eligibility verification and authorizations
Compliance & Documentation
- Maintain HIPAA confidentiality standards
- Follow CMS, Medicare, Medicaid, and commercial payer regulations
- Maintain compliance with Colorado healthcare billing requirements
- Participate in audits and compliance reviews
- Report billing concerns or compliance risks immediately
Communication & Collaboration
- Communicate professionally with providers, patients, insurance companies, and internal staff
- Assist patients with billing questions when needed
- Coordinate with clinical staff regarding documentation corrections
- Participate in team meetings and process improvement initiatives
Qualifications
- High school diploma or equivalent
- Medical billing and coding experience
- Knowledge of ICD-10, CPT, and HCPCS coding systems
- Knowledge of insurance claims processing and denial management
- Experience with EMR/EHR and billing software ( RCM preferred)
- Strong computer and data entry skills
Preferred:
- CPC, CCS, or equivalent coding certification
- Experience with Medicare, Medicaid, commercial insurance, home health billing, clinic billing, and Colorado Medicaid/MCO plans
- Bilingual abilities preferred
The Medical Billing & Coding Administrator is responsible for accurate medical coding, claims submission, payment posting, denial management, and revenue cycle support for medical clinic and healthcare operations. This role ensures compliance with federal, state, payer, and company billing regulations while supporting timely reimbursement and clean claim submission.
The position works closely with providers, front desk staff, clinical teams, insurance companies, and clearinghouses to ensure proper documentation, coding accuracy, and revenue integrity.
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