Coding Specialist / Insurance Reimbursement Specialist in Appleton, Wisconsin at Neuroscience Group

POSITION PURPOSE

Join the team at Neuroscience Group, the region’s leader in brain, spine, and pain care! We are seeking a Coding Specialist / Insurance Reimbursement Specialist to support our Revenue Cycle team in a fast-paced, multi-specialty healthcare environment.

This unique position combines medical coding and insurance reimbursement responsibilities into one dynamic role. The ideal candidate will have experience in both coding and insurance follow-up; however, we are willing to train the right candidate in the area where they may have less experience.

The Coding Specialist / Insurance Reimbursement Specialist serves as a key resource within the Revenue Cycle team by supporting accurate coding, claim reimbursement, denial management, insurance follow-up, and compliance initiatives within a multi-specialty neuroscience practice environment.

This position works collaboratively with providers, billing staff, leadership, patients, and insurance carriers to ensure accurate charge capture, compliant coding practices, timely reimbursement, and resolution of billing discrepancies. The role requires advanced knowledge of medical coding, payer guidelines, reimbursement methodologies, and regulatory compliance standards.

________________________________________

ESSENTIAL FUNCTIONS

Coding & Documentation Responsibilities

• Review and assign appropriate CPT, ICD-10-CM, HCPCS, and modifier coding based on provider documentation, payer requirements, and organizational billing policies.
• Analyze clinical documentation to ensure accurate and compliant coding and charge capture practices.
• Serve as a resource to providers and staff regarding coding guidelines, documentation requirements, and reimbursement policies.
• Assist with coding audits, reviews, and compliance initiatives.
• Identify coding trends, reimbursement concerns, and denial patterns and provide recommendations for improvement.
• Support ongoing education and training related to coding, billing, and documentation requirements.
• Maintain current knowledge of coding updates, payer regulations, and reimbursement guidelines through continuing education, webinars, publications, and professional organizations.

Insurance Reimbursement & Accounts Receivable Responsibilities

• Review payer reports and accounts receivable activity to ensure timely and accurate reimbursement.
• Investigate denied, rejected, underpaid, or unresolved insurance claims utilizing payer portals, electronic systems, and direct communication with insurance carriers.
• Prepare and submit claim appeals and supporting documentation as necessary.
• Work collaboratively with billing staff and leadership to reduce denials and improve reimbursement outcomes.
• Assist with billing work queues, payment posting discrepancies, and reimbursement-related issues.
• Monitor and resolve claim edits and payer-specific billing concerns.
• Recommend process improvements to increase operational efficiency and reimbursement accuracy.

Patient & Customer Service Responsibilities

• Communicate professionally and compassionately with patients regarding billing, insurance, and account-related questions.
• Provide exceptional customer service while maintaining confidentiality and professionalism.
• Assist patients in understanding insurance processing, claim status, and reimbursement concerns.

Compliance & Operational Responsibilities

• Adhere to all organizational policies and procedures related to billing, coding, compliance, and patient confidentiality.
• Maintain compliance with HIPAA, CMS, federal, state, and payer regulations.
• Complete all required compliance and regulatory training.
• Participate in departmental meetings, training sessions, and special projects as assigned.
• Maintain confidentiality of all patient, employee, and organizational information.
• Perform additional duties as assigned to support departmental and organizational operations.

QUALIFICATIONS

Education & Experience

• High school diploma or equivalent required.
• Advanced education or certification in Medical Coding, Health Information Management, Medical Billing, or related field preferred.
• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent certification preferred.
• Minimum of 2–3 years of experience in medical coding, insurance reimbursement, accounts receivable, or medical billing required.
• Experience in a multi-specialty medical practice preferred.

Knowledge, Skills, & Abilities

• Strong understanding of CPT, ICD-10-CM, HCPCS coding, medical terminology, insurance reimbursement, and accounts receivable processes.
• Knowledge of payer guidelines, insurance regulations, and denial management processes.
• Excellent analytical, problem-solving, and critical-thinking abilities.
• Strong organizational skills and attention to detail.
• Ability to multitask and prioritize work in a fast-paced environment.
• Strong verbal and written communication skills.
• Ability to work independently and collaboratively within a team environment.
• Proficiency in electronic health records (EHR), practice management systems, Microsoft Office, and payer web portals.
• Ability to maintain professionalism and confidentiality in all interactions.

________________________________________

TYPICAL PHYSICAL DEMANDS & WORKING CONDITIONS

• Ability to sit for extended periods of time while performing computer and telephone work.
• Requires frequent use of hands for keyboarding and operation of office equipment.
• Requires ability to communicate effectively in person, via telephone, and electronically.
• May require occasional bending, stooping, reaching, or lifting up to 25 pounds.
• Requires visual acuity sufficient to review electronic records and documentation.
• Work is performed primarily in an office or clinical administrative setting with frequent interruptions and multiple competing priorities.

________________________________________

LEGAL & COMPLIANCE STATEMENTS

Neuroscience Group is an Equal Opportunity Employer and complies with all applicable federal, state, and local employment laws. Employment decisions are made without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or genetic information.