Coding and Billing Specialist

Coding & Billing Specialist Role:  The Coding & Billing Specialist is a critical, full-time, salaried position within firsthand’s clinical documentation team. This role is a foundational hire, offering the opportunity to define key processes and program elements for comprehensive and accurate coding of clinical services.

Key Responsibilities - As a specialist in this function, your responsibilities will include:

• Coding & Auditing:
• Perform day-to-day encounter coding for services, procedures, diagnoses, and treatments.
• Verify that all assigned codes (ICD, CPT, and HCPC) are compatible, appropriate, and accurate for billing.
• Audit clinical notes for supporting documentation and code to the highest specificity.
• Use medical terminology to confirm clinical documentation supports the reported diagnoses.
• Conduct coding corrections.
• Claims & Revenue Cycle Management:
• Prepare and submit claims for payment.
• Correct and resubmit rejected claims.
• Maintain Accounts Receivable (A/R) for revenue cycle management.
• Expertise & Process Improvement:
• Serve as the subject matter expert on firsthand's billing systems, including the Electronic Health Record (EHR) and Clearinghouses.
• Advise on and implement ongoing process improvements related to coding and billing.
• Develop and update procedures manuals to ensure correct coding standards and minimize fraud/abuse risk (e.g., revising the master CPT list).
• Education & Support:
• Educate firsthand Advanced Practice Nurses (APNs), Nurse Practitioners (NPs), and other team members on proper code selection, documentation, procedures, and requirements.
• Provide technical guidance to clinical staff in resolving coding issues, such as incomplete or ambiguous documentation.

What You Will Bring

• Experience & Qualifications:
• 4+ years of experience as a medical billing and coding specialist, leveraging an EHR system.
• A High School diploma or equivalent.
• Required Medical Coder Certification: Certified Professional Coder (CPC) from AAPC or Certified Coding Specialist (CCS) from AHIMA.
• Nice-to-have: Certified Risk Adjustment Coder (CRC) from AAPC.
• Skills & Knowledge:
• Strong knowledge of ICD-10-CM and CPT coding guidelines.
• Proficiency in medical terminology, with the ability to read and interpret medical procedures and documentation.
• Expertise in state and federal Medicare reimbursement guidelines.
• Ability to quickly gain proficiency in firsthand’s specific EHR, Clearinghouse, and other billing software.
• Strong multi-tasking skills and consistent attention to detail.
• Excellent written and verbal communication skills for maintaining collaborative relationships with APNs, NPs, the Clinical Documentation Integrity Specialist, and other team members.
• Support firsthand’s mission, vision, and values by demonstrating respect, dignity, empathy, and professional conduct.