Medical Coder

Job Summary:

We are seeking a detail-oriented and experienced Certified Medical Coder specializing in wound care billing to join our team. The ideal candidate will have a strong understanding of coding guidelines, medical terminology, and payer policies related to wound care services. 

The individual will be responsible for accurately assigning CPT, ICD-10-CM, and HCPCS codes, ensuring proper documentation, and optimizing reimbursement while maintaining compliance with federal and state regulations.

Key Responsibilities:

• Medical Coding & Billing: Assign accurate medical codes (CPT, ICD-10, HCPCS) for wound care services, including debridement, skin grafts, and negative pressure wound therapy (NPWT).
• Compliance & Regulations: Ensure adherence to CMS, HIPAA, and payer-specific guidelines to prevent claim denials and audits.
• Communication with Insurance Companies: IVRs and claim status.
• Claim Submission & Follow-Up: Prepare, submit, and monitor claims for wound care procedures, identifying and correcting coding errors to maximize reimbursement.
• Revenue Cycle Support: Work with medical billers, insurance companies, and physicians to resolve claim denials, appeals, and payment discrepancies.
• Documentation Review: Collaborate with healthcare providers to ensure complete and accurate documentation that supports medical necessity and coding compliance.
• Insurance Verification: Assist in verifying insurance coverage, prior authorizations, and medical necessity for wound care treatments.
• Education & Training: Provide guidance to physicians and clinical staff on proper coding practices and documentation improvement.

Qualifications:

• Certifications: CPC (Certified Professional Coder), CCS (Certified Coding Specialist), or equivalent.
• Experience: Minimum 2 years of experience in Medical Billing and Coding, with a focus on wound care services preferred.
• Knowledge: Strong understanding of Medicare, Medicaid, and commercial payer guidelines related to wound care.
• Technical Skills: Proficiency in EHR/EMR systems, coding software (e.g., Encoder Pro, 3M), Microsoft Office, Netsuite, Smartsheet, and ZoHo.
• Analytical & Communication Skills: Ability to analyze medical records, identify coding errors, and communicate effectively with providers and billing teams.

Preferred Skills:

• Experience with modifiers specific to wound care billing.
• Familiarity with Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs) for wound care.
• Background in billing audits and appeals