Coding and Billing Specialist Job Description [Updated for 2025]

In the era of digital healthcare, the importance of Coding and Billing Specialists is more pronounced than ever.

As healthcare systems continue to evolve, the demand for individuals adept at navigating, expanding, and securing our medical billing framework escalates.

But let’s delve deeper: What’s truly expected from a Coding and Billing Specialist?

Whether you are:

• A job seeker trying to understand the core of this role,
• A hiring manager outlining the perfect candidate,
• Or simply intrigued by the intricacies of medical coding and billing,

You’ve come to the right place.

Today, we present a customizable Coding and Billing Specialist job description template, devised for effortless posting on job boards or career sites.

Let’s dive right into it.

Coding and Billing Specialist Duties and Responsibilities

Coding and Billing Specialists manage and oversee all aspects of medical coding and billing within a healthcare setting.

They are responsible for accurately coding diagnoses and procedures, preparing and submitting insurance claims, and managing accounts receivables.

The duties and responsibilities of Coding and Billing Specialists include:

• Assigning correct billing codes for diagnoses and procedures
• Submitting claims to insurance companies and other payers
• Reviewing and appealing unpaid and denied claims
• Verifying patients’ insurance coverage and eligibility
• Answering patients’ billing and payment questions
• Managing account payments and maintaining records of received payments
• Working closely with healthcare providers to clarify diagnoses and to get additional information necessary for accurate billing
• Keeping up-to-date with coding and billing changes and compliance requirements

 

Coding and Billing Specialist Job Description Template

Job Brief

We are seeking a meticulous and analytical Coding and Billing Specialist to manage our medical coding and billing operations.

The specialist will be required to review and analyze medical documentation and bills, accurately code diagnoses and procedures, and submit claims to insurance companies.

Our ideal candidate has a strong background in medical coding and billing with a keen eye for detail.

Proficiency in ICD-10-CM and CPT coding systems and familiarity with medical terminology are key prerequisites for this role.

Ultimately, the role of the Coding and Billing Specialist is to ensure that our operations adhere to legal and insurance standards while facilitating timely payments for medical services rendered.

 

Responsibilities

• Review and analyze medical documentation and patient data
• Accurately code diagnoses and procedures using ICD-10-CM and CPT coding systems
• Prepare and submit claims to insurance companies
• Follow up on unpaid claims and manage collections
• Ensure compliance with federal and state laws, as well as insurance company policies
• Perform regular audits and quality assessments
• Resolve any discrepancies or errors
• Maintain confidentiality and security of patient data
• Communicate effectively with physicians and other healthcare professionals

 

Qualifications

• Proven work experience as a Coding and Billing Specialist, Medical Coder, or similar role in the healthcare industry
• Proficiency in ICD-10-CM and CPT coding systems
• Knowledge of medical terminology and familiarity with hospital procedures
• Excellent attention to detail and analytical skills
• Strong knowledge of insurance policies and regulations
• Ability to maintain patient confidentiality
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) accreditation is preferred
• High school diploma or equivalent; further education in Health Information Management or a related field will be a plus

 

Benefits

• 401(k) plan
• Comprehensive health insurance
• Dental and vision coverage
• Life insurance
• Paid time off
• Continuing education opportunities

 

Additional Information

• Job Title: Coding and Billing Specialist
• Work Environment: Office setting within a healthcare facility. Remote work options may be available.
• Reporting Structure: Reports to the Coding and Billing Manager or Department Supervisor.
• Salary: Salary is based upon candidate experience and qualifications, as well as market and business considerations.
• Pay Range: $40,000 minimum to $60,000 maximum
• Location: [City, State] (specify the location or indicate if remote)
• Employment Type: Full-time
• Equal Opportunity Statement: We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
• Application Instructions: Please submit your resume and a cover letter outlining your qualifications and experience to [email address or application portal].

 

What Does a Coding and Billing Specialist Do?

Coding and Billing Specialists, also known as medical billers and coders, typically work for healthcare facilities such as hospitals, clinics, and private practices.

They can also work for insurance companies or as independent consultants.

They are responsible for translating healthcare services into a billing claim by using a system of standardized codes.

They assign the correct universal medical codes for each patient diagnosis and treatment, ensuring these codes are applied correctly to patient records and billing data.

Their job is to ensure that healthcare providers are accurately reimbursed for the services they provide.

This involves submitting claims to insurance companies and following up on these claims.

In addition to this, they also interact with physicians and other healthcare professionals to clarify diagnoses or to obtain additional information.

They also ensure that the accounts are accurate and that the patients are billed correctly.

Coding and Billing Specialists play a crucial role in the healthcare industry by ensuring that healthcare providers receive the correct compensation for their services and that patients are accurately charged for their treatments.

This job requires strong attention to detail, knowledge of medical terminology, and understanding of insurance billing procedures.

 

Coding and Billing Specialist Qualifications and Skills

A proficient Coding and Billing Specialist should possess the skills and qualifications that are in line with your job description, such as:

• Extensive knowledge of medical terminology, coding, and billing procedures to accurately process patient information and insurance claims.
• Strong attention to detail for ensuring the accuracy and completeness of all billing data and documents.
• Excellent analytical and critical thinking skills to interpret complex patient records, detect any discrepancies and rectify errors in coding and billing.
• Strong mathematical skills to handle billing calculations and understand numerical data.
• Interpersonal skills to liaise with healthcare providers, insurance companies, and patients, ensuring that all billing inquiries and disputes are resolved efficiently.
• Communication skills to explain billing information to patients and other stakeholders, and to communicate effectively with medical professionals about coding.
• Technical abilities to use medical billing software and electronic health records systems, and to adapt to new technologies as they are introduced.
• Problem-solving skills to handle billing disputes, resolve any issues that may arise in the coding and billing process, and identify ways to improve the efficiency and accuracy of billing procedures.

 

Coding and Billing Specialist Experience Requirements

Coding and Billing Specialists typically start their career journey by completing a certificate program or an associate’s degree in medical billing and coding or a related field.

In addition to educational qualifications, practical experience is often required.

Entry-level Coding and Billing Specialist candidates usually have at least 1 to 2 years of experience, possibly acquired through internships or part-time roles in medical billing, coding, or health information management departments.

Candidates with more than 2 years of experience often enhance their technical skills and knowledge in entry-level Coding and Billing Specialist roles.

They may have expertise in specific areas such as coding systems like ICD-10, CPT, and HCPCS, and medical billing software.

For those with over 5 years of experience, they are often seen as more advanced practitioners in the field.

They may have experience in supervisory roles, managing a team of coding and billing specialists.

At this stage, the individual may be ready for managerial or team-lead positions.

Regardless of the level of experience, certifications like Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) are often required and are seen as an advantage.

Continuous education and training are important in this field due to the ever-changing nature of healthcare regulations and coding practices.

 

Coding and Billing Specialist Education and Training Requirements

Coding and Billing Specialists typically require at least a high school diploma or equivalent, but most employers prefer candidates with post-secondary education such as an associate’s degree in Health Information Management or a related field.

Educational programs for coding and billing typically cover medical terminology, anatomy and physiology, health statistics, computer systems, coding and classification systems, healthcare reimbursement methods, healthcare data requirements and standards, and quality improvement methods.

After their formal education, Coding and Billing Specialists often seek certification through a professional organization such as the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA).

These certifications require passing an exam and demonstrate the professional’s proficiency in medical coding, billing, and healthcare regulatory requirements.

Continuing education is also important in this role, as changes in healthcare regulations and insurance company policies often necessitate updates to coding and billing procedures.

Many employers require Coding and Billing Specialists to maintain their certification status, which often involves ongoing training and education.

Apart from the educational requirements, Coding and Billing Specialists should also possess strong attention to detail, excellent organizational skills, proficiency in data entry and basic office software, and a comprehensive understanding of medical terminology and healthcare privacy laws.

 

Coding and Billing Specialist Salary Expectations

A Coding and Billing Specialist can expect an average salary of $40,350 (USD) per year.

The salary can be influenced by factors such as level of experience, certifications, the specific healthcare sector they work in, and the geographical location.

 

Coding and Billing Specialist Job Description FAQs

What skills does a Coding and Billing Specialist need?

A Coding and Billing Specialist should have excellent attention to detail to ensure accuracy in coding and billing processes.

They should have a thorough knowledge of medical terminology, coding standards and insurance practices.

Proficiency in using medical software and strong data entry skills are also required.

Additionally, good communication skills are important as they need to liaise with healthcare providers, insurance companies and patients.

 

Do Coding and Billing Specialists need a degree?

Coding and Billing Specialists do not necessarily need a degree, however, they must have completed a recognized professional coding program.

This could be a diploma or certification program.

These programs typically cover topics such as medical terminology, anatomy, healthcare reimbursement methods, and coding systems.

Additionally, they must obtain a certification, such as the Certified Professional Coder (CPC) credential, which is recognized nationally.

 

What should you look for in a Coding and Billing Specialist resume?

The first thing to look for is certification from a recognized organization.

Experience in a medical office setting and proficiency in using medical software are also important.

Look for knowledge of medical terminology, coding systems, and insurance practices.

If the role requires specialized knowledge, such as coding for a specific medical specialty, look for that experience on the resume.

 

What qualities make a good Coding and Billing Specialist?

A good Coding and Billing Specialist is detail-oriented and highly organized to ensure accuracy in their work.

They should have excellent problem-solving skills to handle any discrepancies or issues in patient billing.

They should be adaptable and willing to continue their education as coding standards and insurance practices can change.

They should also have good interpersonal skills to effectively communicate with healthcare providers, insurance companies, and patients.

 

Is it difficult to hire a Coding and Billing Specialist?

Hiring a Coding and Billing Specialist can be challenging due to the specific set of skills and certification required for the role.

Employers often have difficulty finding candidates who have both the necessary certification and relevant experience.

Offering competitive pay, opportunities for ongoing education and training, and a positive work environment can help attract qualified candidates.

 

Conclusion

And there we have it.

Today, we’ve unraveled the real-world intricacies of being a coding and billing specialist.

Surprise, surprise.

It’s not just about crunching numbers.

It’s about paving the way to smooth healthcare operations, one medical code at a time.

Armed with our comprehensive coding and billing specialist job description template and practical examples, you’re ready to take the next step.

But why end the journey here?

Go further with our job description generator. It’s your tool to creating finely-honed job listings or refining your resume to a tee.

Keep this in mind:

Every medical code is part of a bigger, more crucial picture.

Let’s build that future. Together.

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