MSO - Coding and Billing Specialist in Garner, North Carolina at Community Care of North Carolina Inc

About CCNC

From the mountains to the coast, from large cities to small towns, Community Care of North Carolina is transforming health care. Informed by statewide data and predictive analytics, community-based care-managers work with local physicians and diverse teams of health professionals to develop whole-person plans of care that connect people to the right local resources and increase equity and access to high quality care.

CCNC Mission Statement

To improve the health and quality of life for all North Carolinians by building supporting better community-based healthcare delivery systems.

Position Summary

We are seeking a detailed-oriented and experienced MSO Coding and Billing Specialist with strong coding expertise and hands-on experience across multiple Electronic Medical Record (EMR) systems. This role is responsible for ensuring accurate coding, billing, and reimbursement processes while maintaining compliance with payer and regulatory requirements. The ideal candidate brings a deep understanding of medical coding standards and can quickly adapt to different EMR platforms.

Essential Functions

• Review, code, and submit medical claims accurately using appropriate CPT, ICD-10, and HCPCS codes
• Utilize extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Centers for Medicare and Medicaid Services (CMS) for accurate and optimized assignment and sequencing of diagnostic and procedural codes.
• Able to provide guidance and training on appropriate modifiers according to guidelines. This includes and is not limited to deciding when the modifiers are appropriate to add onto CPT codes.
• Be able to work directly with practices and internal provider relations and EHR specialists to educate and improve the accuracy, completeness, specificity and appropriateness of diagnosis codes, E&M coding based on services rendered and assign appropriate modifiers.
• Able to identify existing or potential problems, gather relevant information, and analyze the information to identify probable causes of problems. Applies knowledge, experience, and common sense and considers alternatives when deciding on the best potential solutions.
• Ensure compliance with federal, state, and payer-specific billing and coding regulations
• Work across multiple EMR systems to manage billing workflows, patient accounts, and claim submissions
• Identify and resolve coding discrepancies, billing errors, and claim denials
• Monitor claim status, follow up on unpaid claims, and coordinate appeals as needed
• Provides measurable, actionable solutions to providers and internal teams that will result in improved accuracy for documentation and coding practices.
• Be a player-coach, serving as a coding expert for your team as well as external and senior stakeholders.
• Interpret, apply, and explain applicable rules and regulations.
• Abide by the American Health Information Management Association (AHIMA) Standards of Ethical Coding and adhere to official coding guidelines.
• Research coding requirements for new and existing contracts.
• Collaborate with clinical and administrative staff to ensure accurate documentation supports coding and billing
• Maintain up-to-date knowledge of coding guidelines, payer policies, and industry best practices
• Generate and analyze billing reports to identify trends and improve revenue cycle performance.
• Coordinating with teams across the organization to relay information.
• Maintains strict confidentiality and follows HIPAA compliance.
• Other job duties as required.

Qualifications

Why Join Us

• Make a meaningful impact on youth and families across North Carolina
• Work with a supportive and collaborative care team
• Competitive Benefits Package effective first day of employment
• Opportunities for growth, training, and bonus incentives*

Ready to improve the health and quality of life of all North Carolinians by building and supporting better community-based health care delivery systems?

• Apply today and join us in delivering compassionate care that makes a difference.