Medical PCP Billing Coder

We are seeking a Certified Medical PCP Billing Coder to join our healthcare team. The ideal candidate will be responsible for accurately coding and billing services rendered by primary care physicians (PCP) in a timely manner while ensuring compliance with all relevant healthcare regulations and payer policies. The Certified Medical PCP Billing Coder will work closely with physicians, medical staff, and insurance companies to ensure accurate claims submission, payment processing, and denial resolution.

Key Responsibilities:

Medical Coding & Billing:

• Review and assign appropriate CPT, ICD-10, and HCPCS codes for office visits conducted by Primary Care Physicians (PCPs).
• Ensure that medical coding is compliant with HIPAA, CMS, and payer-specific billing guidelines.
• Submit claims to insurance companies for reimbursement.

Claims Management:

• Ensure that all claims are submitted timely and follow up on outstanding claims for reimbursement.
• Analyze and resolve claim denials or rejections by interpreting insurance policies, correcting codes, and resubmitting claims.
• Work with the billing team to track patient balances and collect any unpaid fees.

Documentation Review:

• Review physician documentation to ensure it supports appropriate coding and billing.
• Communicate with physicians and other healthcare providers regarding documentation issues that may affect coding accuracy.

Compliance and Quality Control:

• Ensure coding accuracy to reduce claim rejections, denials, and audits.
• Stay updated on industry changes, including coding updates, payer rules, and regulations.
• Maintain compliance with all applicable laws, policies, and procedures.

Reporting & Analytics:

• Prepare coding and billing reports, tracking key performance metrics such as claim accuracy, denial rates, and reimbursement timelines.
• Assist with internal audits and prepare for external audits as necessary.

Qualifications:

Certification: Certified Professional Coder (CPC) certification from the American Academy of Professional Coders (AAPC) or equivalent certification (e.g., Certified Coding Specialist - CCS).

Experience:

• Minimum of [5+] years of experience in medical coding and billing, preferably in a primary care setting.
• Familiarity with ICD-10, CPT, and HCPCS codes.
• Experience with payer-specific billing rules, claims processes, and reimbursement protocols.

Knowledge:

• Comprehensive understanding of healthcare regulations, including HIPAA and the Affordable Care Act.
• Knowledge of Medicare, Medicaid, and private insurance payer requirements and billing procedures.

Preferred Qualifications:

• Experience in a Primary Care Physician (PCP) practice or Family Medicine setting.
• Familiarity with risk adjustment coding (e.g., HCC, RAF) and value-based care reimbursement models.

Job Type: Full-time

Work Location: In person