Billing and Coding Specialist

We're looking for a Billing & Coding Specialist to join our growing Revenue Cycle team. In this role, you'll be an essential partner to our providers and practice teams, ensuring that services are coded accurately, claims are processed efficiently, and reimbursements are maximized. This position combines medical coding, charge entry, claims management, payment posting, and insurance follow-up into one dynamic role.

This position is a full time role, working from our central billing office in Fairfax, VA.  The normal work schedule for this position is Monday through Friday during regular business hours; however, start and end times may be flexible based on operational needs and mutual agreement. 

The ideal candidate is highly detail-oriented, knowledgeable in medical terminology, CPT, HCPCS, and ICD-10 coding, and possesses a strong understanding of medical billing workflows and insurance reimbursement processes. 

Essential Duties and Responsibilities

Medical Coding & Charge Entry

• Review clinical documentation to ensure accurate code selection and charge capture. 
• Assign and validate CPT, HCPCS, and ICD-10 codes based on provider documentation. 
• Review coding accuracy, modifiers, authorizations, and payer-specific billing requirements. 
• Enter charges accurately and timely into the practice management system. 
• Ensure appropriate linkage between diagnoses and procedures. 
• Research and resolve coding discrepancies before claim submission. 

Claims Management

• Prepare, scrub, and submit clean claims electronically and/or via paper claims. 
• Review claims for completeness and compliance with payer guidelines. 
• Monitor claim status and track reimbursement activity. 
• Investigate and resolve rejected, denied, or underpaid claims. 
• Submit corrected claims and appeals when appropriate. 
• Maintain productivity standards for claim review and processing turnaround times. 

Patient & Insurance Data Management 

• Review and verify patient demographic and insurance information. 
• Update patient records and insurance data as needed. 
• Verify eligibility and coverage. 
• Maintain accurate documentation supporting billed services. 

Payment Posting & Reconciliation 

• Post insurance and patient payments accurately. 
• Reconcile payment batches and daily transaction reports. 

Accounts Receivable & Follow-Up

• Follow up on unpaid, denied, or delayed claims. 
• Communicate effectively with insurance carriers regarding claim adjudication. 
• Identify trends contributing to reimbursement delays or denials. 

Customer Service & Collaboration

• Respond professionally to inquiries from patients, providers, practices, and insurance representatives. 
• Partner with providers to communicate documentation or coding concerns. 
• Support special projects and departmental initiatives as assigned. 

Compliance & Quality

• Maintain strict confidentiality in accordance with HIPAA regulations. 
• Adhere to all company policies, payer guidelines, and regulatory requirements. 
• Participate in quality assurance reviews and coding audits. 
• Stay current on coding updates, reimbursement changes, and industry regulations. 

Qualifications 

Education 

• High School Diploma or GED required. 
• Associate degree in Healthcare Administration, Medical Billing and Coding, or related field preferred. 

Experience 

• Minimum of 2 years of medical billing, coding, charge entry, or revenue cycle experience. 
• Experience working with multiple commercial and government payers preferred. 
• Pediatric or primary care practice experience preferred. 

Certifications (Preferred)

• Certified Professional Coder (CPC) 
• Certified Coding Specialist (CCS) 
• Certified Professional Biller (CPB) 

Knowledge, Skills, and Abilities

• Strong knowledge of CPT, ICD-10-CM, HCPCS, and medical terminology. 
• Understanding of revenue cycle management and reimbursement methodologies. 
• Knowledge of claim scrubbing, denials management, and payment posting. 
• Ability to interpret payer policies and medical documentation. 
• Strong analytical and problem-solving skills. 
• Excellent written and verbal communication abilities. 
• Exceptional attention to detail and accuracy. 
• Ability to manage multiple priorities in a fast-paced environment. 
• Proficiency in Microsoft Office Suite, including Excel and Outlook.