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Medical Coder

2 months ago

Cebu, Philippines KMC Solutions Full time

Job Title: Medical Biller/Coder

Department: RCM – Philippines

Reports To: Head of RCM

Job Summary:

The Medical Biller/Coder is responsible for accurately processing and managing billing and coding tasks related to medical and vision care services. This role involves reviewing clinical documentation, assigning appropriate medical codes (CPT, ICD-10, and HCPCS), and ensuring that claims are submitted in compliance with insurance and regulatory requirements. The Medical Biller/Coder will also handle claim rejections, follow up on unpaid claims, and work closely with the RCM team to ensure all services are coded and billed correctly to maximize revenue and minimize claim denials. Attention to detail, a strong understanding of coding guidelines, and excellent communication skills are essential for success in this position.

Required Skills and Qualifications:


• at least 2 years of Medical Billing and/or Coding experience.


• Strong knowledge and understanding of ICD-10, CPT, modifier codes is a must.


• Strong knowledge of Ophthalmology and Vision Care policies and procedures preferred.


• Excellent verbal, written, and interpersonal communication skills.


• Exceptional listening and analytical skills.


• Proficiency in electronic health records (EHR) systems and practice management software.


• Intermediate level of expertise with PC hardware and software (Google Suite).


• Experience with coding audits and compliance activities.


• Strong analytical skills and attention to detail.

Key Roles and Responsibilities:


• Review and analyze clinical documentation from physicians and vision care providers.


• Assign appropriate CPT, ICD-10, and HCPCS codes based on the services provided.


• Ensure accurate and complete documentation is maintained to support coding and billing

activities.


• Prepare and submit claims to insurance companies, Medicare, and other third-party payers.


• Verify that claims follow payer-specific guidelines and regulatory requirements.


• Ensure timely submission of claims to avoid delays in reimbursement.


• Provide feedback to clinical staff on documentation improvement to enhance the accuracy and

efficiency of the billing process.


• Monitor the status of submitted claims, identify and resolve issues related to claim rejections,

denials, or underpayments.


• Follow up on unpaid claims and work to resubmit or appeal as necessary to ensure maximum

reimbursement.


• Track and manage accounts receivable to maintain an accurate record of outstanding payments.


• Provide feedback to clinical staff on documentation improvement to enhance the accuracy and

efficiency of the billing process.


• Generate reports on coding accuracy, claim denial rates, and revenue impacts related to coding

practices.


• Analyze coding data to identify trends, areas for improvement, and opportunities for revenue

optimization


• Collaborate with the billing department to resolve coding-related issues that result in claim

denials or underpayments.


• Provide expertise in coding to assist with claim resubmissions and appeals.


• Analyze denial trends and recommend corrective actions to prevent future coding errors.