The Billing and Coding Specialist must be a self-starter who is able to work independently and as a collaborative team member maintaining their own portfolio of cases. The position requires complex bill reviews to include professional medical services, surgery, inpatient and outpatient services. The Billing & Coding Specialist’s role is to review assigned physician and facility medical coding and billing records to determine if the billed charges are within the usual, customary, and reasonable (UCR) amount, based on cost comparisons in the geographic area, identify medical coding errors, if any, and communicate their review findings in written format (a counter affidavit or cost report). The successful candidate will be motivated, creative, analytical, detail oriented and efficient, and will have superior communication skills, presentation skills, and organizational skills.

Essential Duties and Responsibilities:

Responsible for reviewing and auditing medical codes, procedure codes and facility codes, utilizing industry standard database information and comparing the information to billings submitted by opposing counsel in litigation. If significant differences exist, prepare, and submit a Controverting Affidavit or Cost Report to Counsel to be submitted to the Court or opposing counsel. Must be willing to be deposed by opposing counsel and must be willing to travel to the appropriate court/legal jurisdiction for deposition and/or Trial. 

•  Review and compare opposing counsel’s medical providers billing codes and charges against reasonable and customary charges in a specific geographic region 
• Utilize industry standard database(s) information to assess billed charges for each procedure code. 
• Produce a Controverting Affidavit or Cost Report to be submitted to the Court where charges from opposing counsel’s medical providers are above the usual and customary charges for each medical billing code and procedural code.  
• Be prepared to be deposed by opposing counsel to defend individuals’ credentials, qualifications, findings, and sources as it relates to the submitted Controverting Affidavit 
• Maintain strict confidentiality. 
• Detail oriented, task oriented and excellent time management skills to meet critical legal deadlines.  
• Handle client information about patient treatment, diagnosis, and related identifiable protected healthcare information in accordance with HIPAA-Privacy Rule requirements. 
• Know methodology of several different coding systems, including ICD-10-CM, ICD-10-PCS, CPT, CDT, HCPCS Level II and DRG, along with other relevant databases such as Optum 360, Find-a-Code, and Context 4. 
• Strong computer skills related to bill review software/applications, word processing and spreadsheets. 
• Possess strong written and verbal communication skills and strong PC skills.  
• AAPC or AHIMA credentials strongly preferred.