Medical Biller, Coder, and Claims Scrubber

Job Summary:
We are seeking a detail-oriented and experienced Medical Biller, Coder, and Claims Scrubber to join our pediatric practice. This role is essential in ensuring accurate coding, timely claim submission, and efficient reimbursement for services provided. The ideal candidate will have expertise in medical coding, billing, and claim scrubbing processes, with a strong understanding of pediatric billing guidelines.
Key Responsibilities:
Medical Coding:
• Assign accurate CPT, ICD-10, and HCPCS codes for pediatric procedures and diagnoses.
• Ensure coding compliance with federal regulations, payer policies, and industry standards.
• Stay updated with coding changes and modifications, particularly for pediatric care.
Medical Billing:
• Prepare and submit electronic and paper claims to insurance carriers, Medicaid, and other payers.
• Verify insurance eligibility, benefits as needed.
• Follow up on unpaid or denied claims and appeal when necessary.
• Post payments and adjustments to patient accounts accurately.
Claim Scrubbing & Reimbursement Optimization:
• Review claims for accuracy, completeness, and compliance before submission.
• Identify and correct coding or billing errors to reduce claim denials.
• Work closely with providers and staff to clarify documentation and coding issues.
• Communicate with insurance companies regarding claim processing and reimbursement disputes.
Requirements:
• Certification in Medical Coding (CPC, CCS, or equivalent) preferred.
• 2+ years of experience in medical billing and coding, preferably in a pediatric setting.
• Strong knowledge of ICD-10, CPT, HCPCS, and modifier usage.
• Familiarity with insurance payer policies, Medicaid, and managed care plans.
• Proficiency in electronic health records (EHR) and medical billing software OFFICE PRACTICUM.
• Excellent attention to detail, analytical skills, and problem-solving abilities.
• Strong communication skills and the ability to collaborate with healthcare providers and insurance representatives.
Preferred Qualifications:
• Experience with OFFICE PRACTICUM.
• Knowledge of pediatric-specific coding guidelines and best practices.
• Ability to multitask and manage claim workflows efficiently.
Benefits:
• Friendly and collaborative work environment.
If you are passionate about medical billing, coding, and revenue cycle management in a pediatric setting, we encourage you to apply!