Medical Billing and Coding Specialist job description.
A medical billing and coding specialist translates clinical documentation into standardized codes and submits claims to insurance payers for reimbursement. They ensure accuracy and compliance in coding, follow up on denied claims, and serve as a link between healthcare providers, patients, and insurers.
The Medical Billing and Coding Specialist job description · $29
The full editable .docx — role summary, 8 worked responsibilities, qualifications, and skills, formatted for your letterhead. Delivered to your inbox within 24 hours — usually instantly.
Role: Medical Billing and Coding Specialist Reports to: Billing Manager or Practice Manager
A medical billing and coding specialist translates clinical documentation into standardized codes and submits claims to insurance payers for reimbursement. They ensure accuracy and compliance in coding, follow up on denied claims, and serve as a link between healthcare providers, patients, and insurers.
- Review clinical documentation and assign accurate ICD-10, CPT, and HCPCS codes
- Prepare and submit insurance claims to payers
- Follow up on unpaid, denied, or rejected claims and resubmit as needed
What's inside the document.
One-paragraph plain-English explanation of the role's outcome and scope.
8 responsibilities phrased the way the work is actually done.
4 qualifications a candidate must have to perform on day 30.
3 qualifications that would make a candidate excellent in year two.
6 skill chips you can copy directly into your ATS.
Billing Manager or Practice Manager
A complete document set.
- Word document (.docx) — fully editable
- PDF — signature-ready
- Google Docs — one-click copy to your Drive
- 12 months of updates to this document
- Commercial-use licence for internal and client work
The work, not the title.
- Review clinical documentation and assign accurate ICD-10, CPT, and HCPCS codes
- Prepare and submit insurance claims to payers
- Follow up on unpaid, denied, or rejected claims and resubmit as needed
- Verify patient insurance coverage and eligibility
- Post payments and reconcile accounts receivable
- Communicate with patients regarding billing questions and payment plans
- Maintain compliance with HIPAA and payer-specific billing regulations
- Generate billing and coding reports for management review
Required — and what would make a candidate excellent.
- High school diploma or equivalent; certificate in medical billing and coding preferred
- Knowledge of ICD-10, CPT, and HCPCS coding systems
- Familiarity with insurance claims processes and medical terminology
- Proficiency with billing and electronic health record (EHR) software
- CPC, CCS, or equivalent coding certification
- 1+ years of billing experience in a clinical or hospital setting
- Experience with denial management and appeals
Eight steps from download to publish.
- 01Open the Medical Billing and Coding Specialist job description in Word or your one-click Google Docs copy.
- 02Replace placeholders for company name, reporting line, and location with your specifics.
- 03Tighten the summary to one paragraph that names the team's outcome, not just the role.
- 04Edit the responsibilities to match the actual scope of the seat — aim for 6 to 8 items, not 12.
- 05Separate required qualifications from preferred. Required is what a candidate must have to do the work on day 30; preferred is what would make them excellent in year two.
- 06Add salary range guidance using BLS, Payscale, or your own band data — do not copy generic figures.
- 07Have the hiring manager and one peer read it. Cut anything that wouldn't survive a candidate question.
- 08Publish to your ATS, intranet, and external careers page.
The right document at the right moment.
Use this Medical Billing and Coding Specialist job description any time you are opening or reopening a seat at this level. The entry band sets the calibration — copy the document, tighten it to your specific scope, and circulate to the hiring panel before the first interview.
The reporting line (Billing Manager or Practice Manager) and skills list are starting points. Override either if your org structure or stack differs from the norm — the template is a draft, not a contract.
Honest answers before you download.
- Is certification required for a medical billing and coding role?
- Certification is not always mandatory but is frequently preferred or required, particularly credentials such as CPC or CCS.
- Does this role require direct patient contact?
- Some patient interaction is common, such as answering billing questions, but the role is primarily administrative and does not involve clinical care.
Other documents in this neighbourhood.
Medical Biller
A medical biller prepares and submits claims to insurance payers on behalf of healthcare providers, ensuring accurate coding and timely reimbursement.
Medical Coder
A Medical Coder translates clinical documentation into standardized diagnosis and procedure codes used for billing, insurance claims, and health records.
Patient Access Representative
A Patient Access Representative manages patient intake and registration at hospitals or clinics, verifying insurance, collecting demographic information, and coordinating admissions.
This Medical Billing and Coding Specialist job description is a professionally drafted starting point for your hiring process and is not legal advice. Hiring practice varies by jurisdiction (e.g. pay-transparency laws differ across US states and AU jurisdictions). Adapt this document for your specific location and have employment counsel review any clauses you add before publishing. Salary varies by region, employer type, and experience. Reference BLS or current industry surveys for ranges. Full disclaimer.