Medical Coder

• 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.

• 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.

• 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

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