Physician Billing & Coding Specialist I

Staff_02 Halifax Staffing Inc.; Daytona Beach (FL); On-site; USD 42,000 - 62,000; Full time

Job summary

Halifax Health in Daytona Beach, FL seeks a Day (United States) Physician Billing & Coding Specialist I to support the professional billing lifecycle. You will review clinical documentation for ICD-10, CPT, and HCPCS coding and ensure payer compliance while collaborating with providers, payers, and patients to promote timely reimbursement.

Responsibilities include coding integrity, claims processing, AR follow-up, audits, and thorough documentation in the billing system.

Qualifications

• Knowledge of ICD-10, CPT, HCPCS, HCFA-1500 and professional billing practices.
• Knowledge of Local Coverage Determinations and National Coverage Determinations (LCD/NCD) medical necessity requirements.
• Knowledge of regulatory and third-party payer requirements.
• Professionalism in interpersonal communication with physicians, colleagues, and ancillary departments.
• Ability to organize, prioritize, analyze and implement daily tasks; must be a self-starter.
• Ability to handle multiple responsibilities and tasks in stressful situations.
• Maintain confidentiality; knowledge of HIPAA laws.
• Proficiency with billing systems, specifically Epic.

Responsibilities

• Review physician medical records to extract and assign appropriate ICD-10, CPT, and HCPCS codes for professional billing.
• Maintain knowledge of LCD/NCD, payer policies, and regulatory changes.
• Comply with internal coding standards, government regulations, and third-party payer requirements.
• Process professional claims accurately and timely in accordance with payer-specific guidelines.
• Correct and resubmit rejected, denied, or pending claims; follow up with insurance carriers to ensure timely payment.
• Analyze remittances and explanation of benefits (EOBs) to determine appropriate payment application, adjustments, or patient responsibility.
• Assist with internal and external payer and compliance audits
• Assign and track follow-up dates to prevent timely-filing issues.
• Maintain accurate documentation and notes in billing system.
• Work assigned account work queues daily to ensure timely resolution.
• Respond to written and electronic correspondence within required timeframes.
• Adhere strictly to HIPAA, organizational ethics standards, and corporate compliance policies.
• Maintain confidentiality of all patient and financial information.
• Demonstrate ethical and professional conduct in all interactions.
• Assist coworkers and departments as needed.
• Maintain flexibility to support multiple functional; Revenue Cycle areas.
• Perform additional duties as assigned by management.

Skills

ICD-10/CPT/HCPCS

LCD/NCD knowledge

Regulatory/payer knowledge

Interpersonal communication

Time management

HIPAA confidentiality

Epic billing systems

Education

High school diploma or equivalent

Associate’s or Bachelor’s degree preferred (Health Information Management, Business, or related field)

Tools

Epic

Job description

Day (United States of America) Physician Billing & Coding Specialist I

The Physician Billing & Coding Specialist I is responsible for supporting the professional billing lifecycle, including physician coding, charge review and reconciliation, billing, and A/R follow-up. This role reviews clinical documentation for accurate ICD-10, CPT, and HCPCS code assignment; ensures compliance with regulatory and payer requirements; resolves patient and third-party account issues; and serves as a liaison between providers, payers, and patients to promote timely, accurate reimbursement.

Education

• High school diploma or equivalent required
• Associate’s or Bachelor’s degree preferred (Health Information Management, Business, or related field)

Experience

• Minimum of two (2) years’ experience in healthcare coding, billing, patient accounting, or revenue cycle operations
• Hospital or physician billing experience preferred

Certifications (Required)

• CPC, CCS-P, CCSP, or equivalent coding certification
• Certification required within 6 months of hire date

Skills, Experience and Licensure

• Knowledge of ICD-10, CPT, HCPCS, HCFA-1500, and professional billing practices
• Knowledge of Local Coverage Determinations and National Coverage Determinations (LCD/NCD) medical necessity requirements
• Knowledge of regulatory and third-party payer requirements
• Professionalism in interpersonal communication skills with physicians, colleagues, and ancillary departments required
• The ability to organize, prioritize, analyze, and implement daily tasks; must be a self-starter
• The ability to handle multiple responsibilities and tasks in stressful situations
• The ability to maintain confidentiality; knowledge of HIPAA laws
• Proficiency with billing systems, specifically Epic

Duties and Responsibilities

Physician Coding & Documentation Integrity

• Review physician medical records to extract and assign appropriate ICD-10, CPT, and HCPCS codes for professional billing.
• Maintain knowledge of Local and National Coverage Determinations (LCD/NCD), payer policies, and regulatory changes.
• Comply with internal coding standards, government regulations, and third-party payer requirements.

Billing & Accounts Receivable Management

• Process professional claims accurately and timely in accordance with payer-specific guidelines.
• Correct and resubmit rejected, denied, or pending claims; follow up with insurance carriers to ensure timely payment.
• Analyze remittances and explanation of benefits (EOBs) to determine appropriate payment application, adjustments, or patient responsibility.
• Assist with internal and external payer and compliance audits
• Assign and track follow-up dates to prevent timely-filing issues.

Other Responsibilities

• Maintain accurate documentation and notes in billing system.
• Work assigned account work queues daily to ensure timely resolution.
• Respond to written and electronic correspondence within required timeframes.
• Adhere strictly to HIPAA, organizational ethics standards, and corporate compliance policies.
• Maintain confidentiality of all patient and financial information.
• Demonstrate ethical and professional conduct in all interactions.
• Assist coworkers and departments as needed.
• Maintain flexibility to support multiple functional; Revenue Cycle areas.
• Perform additional duties as assigned by management.

We're glad you're here. As a cornerstone of our community, we need strong, compassionate and talented medical professionals just like you. Our team works together to ensure that families receive the highest-quality care in a pleasant setting where they feel valued.

Recognized as one of the 50 Top Cardiovascular Hospitals in the United States by IBM Watson Health, Halifax Health serves Volusia and Flagler counties, providing a continuum of health care services through a network of organizations including a tertiary hospital, two community hospitals, urgent care clinics, psychiatric services, a cancer treatment center with five outreach locations, the area’s largest hospice, a center for inpatient rehabilitation, outpatient rehabilitation clinics, primary care walk-in clinics, a clinic specializing in women’s health, a pediatric care community clinic, five pediatric medical practices, a home health care agency and an exclusive provider organization. Halifax Health offers the area’s only Level II Trauma Center, Thrombectomy-Capable Stroke Center (TSC), Center for Transplant Services, Pediatric Intensive Care Unit, Child and Adolescent Behavioral Services, complete Neurosurgical Services, OB Emergency Department and Level III Neonatal Intensive Care Unit that cares for babies born earlier than 28 weeks.