Job Title:

Medical Insurance Reimbursement & Coding Specialist


Job Description:


The Medical Insurance Reimbursement & Coding Specialist is responsible for directing and coordinating the overall functions of the Patient Services department to ensure maximization of cash flow while improving patient, physician, and third party knowledge.


Essential Duties and Responsibilities:


  • Develops, implements and oversees billing and coding policies and procedures
  • Conducts ongoing evaluation of billing and coding policies and procedures to optimize efficiency and ensure compliance with regulatory and contract requirements.
  • Trains and evaluates staff with regards to billing procedures and policies to ensure compliance.
  • Reviews current status of patient accounts to identify and resolve billing and processing problems in a timely manner.
  • Maintains contacts with medical records and other departments to obtain and analyzes additional patient information for documenting and processing billing.
  • Responsible for processing all charge entry functions ensuring that accurate and up to date CPT/ICD-9 codes are used; reviews for current insurance, co-pays and sliding fees prior to submit billing; keeps providers and PSR personnel up to date with same.
  • Responsible for timely submission of patient billing information to outside billing agency.
  • Oversees compliance with payor contacts ensuring that claims are paid timely and accurately and manages payment processes.
  • Identifies and resolves patient billing complaints.
  • Evaluates patient’s financial status and establishes budget payment plans. Follows and reports status of delinquent accounts.
  • Maintains knowledge of and complies with established policies and procedures including government, insurance, and third party payor regulations.
  • Provides detail reports of revenue, A/R, rejections and any vendor changes.
  • Performs month end close and ensures that Comptroller and government agencies receives the necessary reports in a timely manner.


Minimum Qualifications:                 

  • This position requires a High School Diploma or equivalent (Degree desirable, but not required)
  • 1 – 2 years related experience
  • Proficient in medical terminology and CPT/ICD-9 coding.
  • Knowledge or experience with FQHC billing practices and reimbursement regulations.
  • Strong interpersonal and communication skills required.
  • Must be detail oriented, have strong organizational skills, and the ability to communicate with multiple types of people.
  • Strong teamwork orientation.
  • Positive attitude and professional customer service skills.



Skills, Knowledge, and Abilities:


  • Demonstrates an independent work initiative, sound judgment and attention to detail
  • Ability to read, write, speak and understand English.
  • Requires experience and demonstrated abilities for working in a multi-cultural setting.
  • Ability to collaborate and interact with a diverse group of professionals.
  • Ability to organize and prioritize work appropriately.
  • Demonstrated ability to interact with both business and technical personnel to solve business challenges
  • Strong written and oral communication skills
  • Demonstrated problem solving and analytical skills


Other Qualifications:


To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


Although certification is not required for hire for this position, candidates must be willing to obtain certification within twelve (12) months of hire through company-sponsored training and development program.

For consideration, all candidates must successfully complete pre-employment process, which includes: skills assessment, drug & alcohol screening, interview, physical examination, etc… This position offers a competitive compensation package, outstanding benefits including Health, Dental, Disability, and Vision Insurance, 401k, and a great working environment.

Salary Range

  • $11.00 – $31.65/hour

Working Conditions

  • 8 hour shift
  • Monday – Friday
  • Full time: 40+ hours per/week

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