Certified Medical Biller/Coder (DIRECT HIRE ONLY)
HybridWyoming, United States or Wyoming, Michigan, United States
Job Summary
Manage the complete claims lifecycle, including charge review, submission, correction, and follow-up through resolution using TriZetto and eClinicalWorks. Accurately assign CPT, ICD-10-CM, and HCPCS codes while reviewing clinical documentation to ensure compliance and resolve provider queries. Monitor accounts receivable, investigate denials, and prepare appeals to recover payments, while maintaining accurate records of all payer communications. Work patient balances respectfully before external collection, interpret eligibility information for families, and support front-desk staff with complex financial situations. Track revenue cycle indicators like denial trends and clean-claim rates to provide leadership with actionable updates.
Required Qualifications
- Coding certification: AAPC Certified Professional Coder (CPC), AHIMA Certified Coding Specialist (CCS), or AHIMA Certified Coding Specialist - Physician-based (CCS-P)
- Outpatient/clinic revenue cycle experience (billing, coding, A/R follow-up, and patient balances)
- Strong understanding of EOBs, denials, payer rules, and patient responsibility (copays, coinsurance, deductibles)
- Ability to communicate warmly and clearly with families about finances while holding firm to clinic policies
- High integrity and commitment to compliance, accuracy, and patient experience
Desired Qualifications
- TriZetto experience (clearinghouse workflow proficiency)
- Experience in eClinicalWorks (eCW)
- Experience in pediatric behavioral health / testing-adjacent billing environments (or similarly complex outpatient services)
- Process-improvement mindset (clean claim rate, denial reduction, A/R days improvement)
- Credentialing experience (provider enrollment + re-credentialing) with demonstrated ability to manage timelines and payer requirements
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