Medical Billing & Coding Specialist

Concord OB/GYN Associates, PC; United States; Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health Insurance with HSA

Dental Insurance

Vision insurance

Paid Time Off

Job summary

Concord OB/GYN Associates, PC is seeking a Billing & Coding Specialist to optimize receivables and cash flow. The role requires expert OB/GYN coding, documentation review, and strong interaction with patients and providers.

The ideal candidate will independently resolve billing issues, handle denials, and ensure regulatory compliance while supporting the billing team. The position emphasizes collaboration with EPIC, Athena, and related billing tools, maintaining confidentiality and delivering

Qualifications

• Active coding certification through AAPC or AHIMA is required.
• Minimum three to five years healthcare billing and coding experience.

Responsibilities

• Serve as the subject matter expert for all billing, coding, and documentation questions.
• Review provider documentation for accurate coding and compliance with guidelines.
• Post charges for office, hospital outpatient, and hospital inpatient services including E/M visits and obstetric care.
• Conduct billing and documentation audits to support accurate coding and reimbursement.
• Manage accounts receivable activities, including denials, appeals, and payment plans.
• Coordinate referrals, prior authorizations, and cost estimates with patients and payers.
• Maintain HIPAA compliance and protect sensitive information.

Education

AAPC or AHIMA certification (CPC, CCS, CPB, COBGC)

Tools

EPIC

Athena

OB TraceView

ViewPoint

Job description

OVERVIEW:

The Billing & Coding Specialist works collaboratively with the billing team to support all functions of the billing department, ensuring the maximization of receivables and maintaining optimal cash flow. This role requires advanced knowledge of OB/GYN coding and billing practices. The Billing & Coding Specialist is responsible for maintaining compliance with office policies, procedures, and all applicable regulatory requirements.

The ideal candidate demonstrates a friendly and professional demeanor, strong interpersonal skills, and the ability to remain composed during high-pressure situations. This role requires the ability to work independently, apply critical thinking to resolve complex billing issues, and manage sensitive financial conversations with patients in a respectful and understanding manner.

KEY RESPONSIBILITIES:

• Serve as the subject matter expert for all billing, coding, and documentation questions.
• Review provider documentation to ensure accurate coding, appropriate modifier usage, and compliance with billing guidelines.
• Review and post charges for office, hospital outpatient, and hospital inpatient services, including:
  • E&M visits, OB visits, annual visits, immunizations, procedures.
  • NSTs, IV hydration, ultrasound technical services.
  • FamilyWell behavioral health services.
  • Surgical procedures, and Labor & Delivery services.
• Conduct billing and documentation audits and provide feedback to providers and billing staff to support accurate coding and appropriate reimbursement.
• Maintain current coding resources, documentation guidelines, and billing tools.
• Manage accounts receivable activities, including claim rejections, denials, appeals, payer discrepancies, refunds, overdue accounts, and patient payment plans.
• Collaborate with insurance carriers and third-party payers to resolve billing issues and maximize appropriate reimbursement.
• Coordinate, complete and/or oversee the patient referral, prior authorization, and cost estimate request processes.
• Maintain accurate insurance carrier and plan information, including participation status and referral requirements.
• Answer incoming Billing Department telephone calls and assist patients with billing questions, concerns, and account inquiries. Provide clear, accurate, and courteous explanations to ensure patients understand their account information and any necessary next steps.
• Utilize EPIC, Athena, OB TraceView, and ViewPoint to ensure accurate billing, documentation, and processing of patient services.
• Manage Athena Interface Message Queue Manager and EPIC worklists, including Eligibility Workqueue and Missing Registration Items.
• Ensure billing operations comply with practice policies, payer requirements, and applicable federal and state regulations.
• Maintain strict confidentiality of patient, employee, physician, and organizational information in accordance with HIPAA and applicable privacy requirements.

QUALIFICATIONS:

Required

• Active coding certification through AAPC or AHIMA: CPC, CCS, CPB, COBGC, or similar certification required. Other professional coding certifications may be considered on a case-by-case basis in combination with work experience.
• Minimum three (5) years healthcare billing and coding experience with a deep understanding of medical billing rules and regulations.
• Thorough understanding of medical billing, collections and payment posting, revenue cycle, third party payers, Medicare; strong knowledge of Massachusetts and Federal payer regulations.
• Thorough knowledge of CPT and ICD-10-CM, HCPCS Level II coding systems.
• HIPAA, billing and insurance regulations, medical terminology, insurance benefits and appeal processes.
• Understanding of medical terminology, anatomy, and physiology related to obstetrics and gynecology.
• Ability to interpret clinical documentation and apply coding guidelines accurately.

Preferred

• Experience with EPIC EMR system a plus.
• Experience with Athena RCM system a plus.
• Experience coding maternity care, including antepartum, delivery, and postpartum services is helpful.
• Experience with gynecologic office procedures and surgical coding.
• Familiarity with payer requirements and coding edits related to OB/GYN services.
• Experience responding to coding audits, providing feedback, or resolving denials.

BENEFIT PACKAGE:

• Health Insurance with HSA funded by employer.
• Dental Insurance, Vision, Short Term Disability, Accident, Critical Illness, Hospital Indemnity, Long Term Care & Life, Term Life, Legal Services, Pet Wellness and Travel 365 Insurance available.
• Paid Time-Off
  • Vacation: 3 weeks / year
  • Personal: 1 day / year
  • Sick: 1 week / year
• Holiday Pay (11 days)
• 401k (Traditional & Roth)
• 401k Matching up to 6% of yearly salary.
• Profit Sharing
• Reimbursement of Certification Dues and Licensing Fees.
• Bonus Eligible
• Massachusetts Paid Family & Medical Leave