Medical Biller & Coder

Advanced Pain Solutions, LLC; Fresno (CA); On-site; USD 52,000 - 70,000; Full time

Job summary

Advanced Pain Solutions, LLC is seeking a diligent Medical Biller & Coder to manage accurate coding (ICD-10-CM, CPT, HCPCS) and timely billing for both the medical practice and ASC services in Fresno, CA. You will ensure correct reimbursement, reduce denials, and maintain portal access and compliance.

Responsibilities include posting payments, reviewing claims, and collaborating with providers and payers to resolve discrepancies. EHR experience and relevant CPC/COC/CCS credentials are preferred.

Qualifications

• Experience in medical billing and coding for physician practices and ambulatory surgery centers.
• Knowledge of ICD-10-CM, CPT, HCPCS, modifiers, and reimbursement guidelines.
• Experience with Medicare, Medi-Cal, commercial insurance, and workers' compensation billing.
• Familiarity with pain management, interventional procedures, and surgical coding.
• Experience with electronic health records and practice management systems; CPC/COC/CCS preferred.
• CPC/COC/CCS or equivalent certification preferred.

Responsibilities

• Code ICD-10-CM, CPT, and HCPCS for office visits and procedures.
• Review documentation for coding accuracy and completeness.
• Submit clean claims to Medicare, Medi-Cal, and commercial carriers.
• Post payments, adjustments, and patient balances; follow up on denials.
• Monitor aging reports and assist with appeals when needed.
• Maintain compliance with HIPAA and payer requirements.

Skills

Medical billing

Medical coding

Denials management

Accounts receivable

Attention to detail

HIPAA compliance

Communication skills

Education

CPC certification

COC certification

CCS certification

Tools

eClinicalWorks

Job description

Job Description

MEDICAL BILLER & CODER

Advanced Pain Solutions (APS) | Ky Advanced Surgery Center (KASC)

Department: Billing & Revenue Cycle Management
Reports To: Practice Administrator / Management
Position: Medical Biller & Coder

Position Summary

The Medical Biller & Coder is responsible for accurate and timely medical coding, insurance billing, claims processing, payment posting, and revenue cycle management for both the medical practice and ambulatory surgery center (ASC).

This position ensures proper reimbursement, minimizes billing errors and denials, maintains administrative access to designated insurance portals, and ensures compliance with insurance requirements and applicable regulations.

Essential Duties & Responsibilities

1. Medical Coding & Documentation

• Accurately assign ICD-10-CM, CPT, and HCPCS codes for office visits, procedures, and surgical services.
• Review provider documentation, operative reports, and treatment plans for coding accuracy and completeness.
• Apply appropriate modifiers, units, and place-of-service codes.
• Ensure professional and ASC facility claims are coded and billed correctly and separately when applicable.
• Identify documentation discrepancies and coordinate corrections with providers before billing.

2. Billing & Claims Processing

• Prepare, review, and submit clean claims to Medicare, Medi-Cal, commercial insurance, and workers' compensation carriers.
• Verify patient insurance information, authorizations, and billing requirements.
• Monitor claims for timely submission and reimbursement.
• Correct rejected claims and resubmit promptly.
• Ensure accurate billing of office visits, injections, interventional procedures, and ASC facility services.

3. Accounts Receivable & Payment Posting

• Post insurance payments, adjustments, and patient payments accurately.
• Monitor outstanding accounts receivable and follow up on unpaid or underpaid claims.
• Investigate and resolve claim denials, rejections, and payment discrepancies.
• Prepare and submit appeals with supporting documentation.
• Review aging reports and prioritize outstanding balances.

4. Revenue Cycle Management

• Review claims for coding errors, missing charges, incorrect modifiers, and incomplete documentation.
• Identify opportunities to improve collections and reduce denials.
• Reconcile billed services with provider schedules and completed procedures to prevent missed charges.
• Monitor billing performance, collections, and reimbursement trends.
• Communicate billing concerns and financial discrepancies to management.
• Assist with resolving outstanding claims and collecting reimbursement for services rendered.

5. Compliance & Communication

• Maintain compliance with HIPAA, CMS, payer contracts, and applicable coding and billing guidelines.
• Stay current on coding changes, reimbursement policies, and ASC billing regulations.
• Communicate effectively with providers, clinical staff, insurance representatives, and management.
• Maintain confidentiality of patient and financial information.
• Participate in billing audits, staff training, and workflow improvements.

6. Insurance Portal Access & Administration

• Maintain authorized access and administrative rights to the clearinghouse, Medicare, UnitedHealthcare, and Blue Cross Blue Shield provider portals for both APS and KASC, as applicable.
• Manage user accounts, permissions, and access for authorized billing personnel.
• Monitor claims, eligibility, payment status, denials, and appeals through insurance portals.
• Maintain updated provider information, account credentials, and enrollment records.
• Ensure portal access is secure, confidential, and compliant with HIPAA and company policies.
• Promptly address account access issues, portal updates, and billing-related discrepancies.
• Coordinate with management regarding account administration, access changes, and security concerns.
• Ensure management maintains appropriate oversight and access to all billing platforms and insurance portals.

Qualifications

• Previous medical billing and coding experience required; experience in both physician practice and ambulatory surgery center billing preferred.
• Knowledge of ICD-10-CM, CPT, HCPCS, modifiers, and insurance reimbursement guidelines.
• Experience with Medicare, Medi-Cal, commercial insurance, and workers' compensation billing.
• Familiarity with pain management, interventional procedures, and surgical coding preferred.
• Experience with electronic health records and practice management systems; eClinicalWorks experience preferred.
• CPC, COC, CCS, or equivalent certification preferred.
• Strong organizational skills, attention to detail, and ability to meet deadlines.

Performance Expectations

• Submit accurate claims promptly and within payer filing deadlines.
• Maintain low claim rejection and denial rates.
• Follow up consistently on unpaid claims and outstanding balances.
• Identify and communicate billing errors before they affect reimbursement.
• Maintain accurate, organized billing records.
• Maintain active and secure access to all assigned clearinghouse and insurance portals.
• Demonstrate accountability, professionalism, and effective communication.
• Assist in maximizing collections and maintaining the financial stability of APS and KASC.
• Provide management with timely updates regarding billing issues, unresolved claims, and reimbursement delays.