Medical Coder

1 day ago

Quezon City, National Capital Region, Philippines CF Outsourcing Solutions Full time


Job Summary:

We are seeking a detail-oriented and experienced Certified Medical Coder specializing in wound care billing to join our team. The ideal candidate will have a strong understanding of coding guidelines, medical terminology, and payer policies related to wound care services. 

The individual will be responsible for accurately assigning CPT, ICD-10-CM, and HCPCS codes, ensuring proper documentation, and optimizing reimbursement while maintaining compliance with federal and state regulations.

Key Responsibilities:

  • Medical Coding & Billing: Assign accurate medical codes (CPT, ICD-10, HCPCS) for wound care services, including debridement, skin grafts, and negative pressure wound therapy (NPWT).
  • Compliance & Regulations: Ensure adherence to CMS, HIPAA, and payer-specific guidelines to prevent claim denials and audits.
  • Communication with Insurance Companies: IVRs and claim status.
  • Claim Submission & Follow-Up: Prepare, submit, and monitor claims for wound care procedures, identifying and correcting coding errors to maximize reimbursement.
  • Revenue Cycle Support: Work with medical billers, insurance companies, and physicians to resolve claim denials, appeals, and payment discrepancies.
  • Documentation Review: Collaborate with healthcare providers to ensure complete and accurate documentation that supports medical necessity and coding compliance.
  • Insurance Verification: Assist in verifying insurance coverage, prior authorizations, and medical necessity for wound care treatments.
  • Education & Training: Provide guidance to physicians and clinical staff on proper coding practices and documentation improvement.

Qualifications:

  • Certifications: CPC (Certified Professional Coder), CCS (Certified Coding Specialist), or equivalent.
  • Experience: Minimum 2 years of experience in Medical Billing and Coding, with a focus on wound care services preferred.
  • Knowledge: Strong understanding of Medicare, Medicaid, and commercial payer guidelines related to wound care.
  • Technical Skills: Proficiency in EHR/EMR systems, coding software (e.g., Encoder Pro, 3M), Microsoft Office, Netsuite, Smartsheet, and ZoHo.
  • Analytical & Communication Skills: Ability to analyze medical records, identify coding errors, and communicate effectively with providers and billing teams.

Preferred Skills:

  • Experience with modifiers specific to wound care billing.
  • Familiarity with Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) for wound care.
  • Background in billing audits and appeals

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