Job Description
Location: Washington State
Employment Type: Part-Time
Reports To: COO
Position SummaryThe Medical Billing and Coding Specialist is responsible for accurately coding medical services, submitting insurance claims, and ensuring timely reimbursement in compliance with federal regulations, Washington State laws, and payer-specific guidelines. This role plays a critical part in maintaining revenue cycle integrity while supporting compliance with HIPAA and Washington healthcare regulations.
Key ResponsibilitiesMedical Coding• Assign accurate ICD-10-CM, CPT, and HCPCS Level II codes to diagnoses, procedures, and services.
• Review clinical documentation to ensure coding accuracy and completeness.
• Ensure compliance with CMS guidelines, Washington State Medicaid (Apple Health) requirements, and commercial payer policies.
• Identify documentation deficiencies and communicate with providers for clarification.
Medical Billing• Prepare and submit clean electronic and paper claims to insurance carriers.
• Monitor claim status and resolve rejections or denials promptly.
• Post payments, adjustments, and patient payments accurately.
• Process appeals and corrected claims when necessary.
• Verify insurance eligibility and benefits when required.
Compliance & Regulatory Adherence• Maintain strict adherence to HIPAA Privacy and Security Rules and Washington State healthcare regulations.
• Stay current on Washington State Medicaid billing updates and payer changes.
• Participate in internal audits and compliance reviews.
• Ensure adherence to Federal False Claims Act guidelines.
Revenue Cycle Support• Analyze denial trends and recommend process improvements.
• Assist with patient billing inquiries and payment arrangements.
• Support month-end reporting and reconciliation.
• Maintain accurate patient financial records in the practice management system.
Required Qualifications• High School Diploma or GED (Associate degree preferred).
• Certification required: CPC (AAPC) or CCS (AHIMA).
• Minimum 2 years of medical billing and coding experience.
• Strong knowledge of ICD-10-CM, CPT, HCPCS, and E/M coding guidelines.
• Experience with Washington Apple Health (Medicaid) preferred.
• Proficiency in EHR and billing software systems.
• Strong attention to detail and analytical skills.
Preferred Qualifications• Experience in specialty billing (e.g., SNF, laboratory, primary care, etc.).
• Knowledge of Washington State L&I (Labor & Industries) billing requirements.
• Familiarity with payer portals and clearinghouses.
• Experience with revenue cycle analytics.
CompensationBased on experience $21-24 per hour
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