Billing & Coding Specialist

Description

Billing and Coding Specialist

Drive Revenue. Prevent Denials. Eliminate Rework.

Position Impact

The Billing and Coding Specialist accelerates revenue capture by ensuring clean claims submission, preventing denials before they occur, and proactively identifying coding issues that cause delays. Your success is measured by first-pass claim acceptance rates, reduced denial rates, and faster cash flow achieved through accurate, timely charge entry. This role directly impacts revenue performance by eliminating rework, preventing payment delays, and catching problems before they become costly denials.

Core Responsibilities

Maximize Revenue Through Clean Claims Submission

• Ensure charges result in clean claims that pay on first submission without denials or rejections
• Prevent revenue loss by catching coding errors before claims are submitted
• Accelerate cash flow through timely charge entry, enabling faster billing cycles
• Apply correct CPT, ICD-10, and HCPCS codes that maximize appropriate reimbursement
• Reduce claim rework and resubmissions that delay payment receipt
• Maintain high accuracy rates that minimize denials impacting collections

Proactively Identify and Eliminate Recurring Issues

• Recognize provider documentation patterns causing repeated coding problems
• Escalate systematic issues to prevent ongoing denials and revenue delays
• Alert management to trends before they impact multiple claims
• Partner with providers to improve documentation supporting clean claims
• Identify and communicate training needs that will reduce future errors
• Take initiative to solve problems rather than repeatedly coding around them

Drive Quality That Prevents Downstream Revenue Problems

• Catch laterality mismatches, documentation gaps, and coding errors before submission
• Ensure diagnosis codes support medical necessity, preventing claim denials
• Review clinical notes thoroughly to identify issues AR teams would face later
• Maintain accuracy standards that eliminate costly denial and appeal work
• Perform quality self-checks preventing errors that create collection obstacles
• Focus on getting claims right the first time to avoid revenue cycle delays

Accelerate Charge Processing and Reduce Lag Time

• Enter charges promptly, enabling timely claim submission and faster payment
• Minimize charge lag that delays billing cycles and extends days to payment
• Process high volume efficiently while maintaining quality standards
• Prioritize work that has the greatest impact on revenue timing
• Meet productivity targets supporting departmental cash flow goals
• Eliminate backlogs that prevent timely revenue capture

Resolve Documentation Issues That Block Revenue

• Identify missing information preventing accurate charge entry
• Follow up with providers and clinical staff to obtain documentation needed for coding
• Clear obstacles quickly so charges can be processed without delays
• Ensure supporting documentation meets payer requirements for reimbursement
• Prevent claims from aging in unbilled status due to incomplete information
• Drive the resolution of documentation gaps that would cause denials

Performance Expectations

• Achieve high first-pass claim acceptance rates through coding accuracy
• Maintain error rates that minimize denials and collection delays
• Process charges within timeframes supporting optimal cash flow
• Proactively escalate recurring issues preventing future revenue loss
• Meet daily productivity targets, enabling timely billing cycles
• Reduce charge lag, minimizing days to claim submission
• Contribute to departmental goals for clean claim rates and denial reduction
• Demonstrate outcome focus by preventing problems rather than just processing tasks

Qualifications

Required

• 2+ years of medical billing and coding experience
• Strong understanding of CPT, ICD-10, and HCPCS coding systems
• Proven ability to maintain high accuracy while processing high volume
• Knowledge of medical terminology and clinical documentation
• Attention to detail with a focus on preventing errors before submission
• Proactive problem-solver who escalates issues and drives solutions
• Ability to work independently in a remote environment
• Proficiency with MS Office, Excel, and practice management systems

Preferred

• CPC certification or working toward certification
• Knowledge of personal injury billing and documentation requirements
• Familiarity with NextGen or similar healthcare systems
• Track record of high accuracy and low denial rates
• Experience identifying and resolving systematic coding issues

The Ideal Candidate

• Views coding as revenue enablement, not just data entry
• Takes ownership of claim outcomes, not just task completion
• Proactively identifies problems and escalates before they impact multiple claims
• Recognizes patterns and addresses root causes rather than repeating workarounds
• Demonstrates urgency around charge timing and its impact on cash flow
• Shows initiative in resolving documentation issues that block revenue
• Maintains quality focus, understanding that accuracy prevents costly rework
• Thinks strategically about preventing denials rather than just processing charges

Compensation & Benefits

• Competitive hourly rate with performance-based bonus potential
• Remote work flexibility
• Comprehensive benefits: medical, dental, vision, 401(k)
• Professional development support, including certification and continuing education
• Clear advancement pathway to Senior Specialist, Auditor, or Team Lead roles

About AICA Orthopedics

AICA Orthopedics is Atlanta's premier integrated healthcare provider with 24 locations, specializing in orthopedic, neuro-spine, and pain management services. For 25 years, we've delivered exceptional multidisciplinary care through our team of 400+ professionals.

Work Environment

• 40 hours per week with occasional extended hours to meet deadlines
• Fast-paced environment focused on quality and productivity
• Regular communication with the team via phone, email, and video conferencing
• Self-directed work requiring strong time management and accountability

Requirements

Required

2+ years of medical billing and coding experience

Strong understanding of CPT, ICD-10, and HCPCS coding systems

Proven ability to maintain high accuracy while processing high volume

Knowledge of medical terminology and clinical documentation

Attention to detail with a focus on preventing errors before submission

Proactive problem-solver who escalates issues and drives solutions

Ability to work independently in a remote environment

Proficiency with MS Office, Excel, and practice management systems

Preferred

CPC certification or working toward certification

Knowledge of personal injury billing and documentation requirements

Familiarity with NextGen or similar healthcare systems

Track record of high accuracy and low denial rates

Experience identifying and resolving systematic coding issues