Remote Medical Billing, Coding & Documentation Specialist (Wound Care Focus)

Company Overview Smoky Mountain Wound Care (SMWC) is a growing mobile wound care provider serving patients across Tennessee. We bring advanced, evidence-based wound management directly to patients’ homes and facilities — focusing on quality, compliance, and compassionate care. We are seeking a highly skilled Medical Billing, Coding, and Documentation Specialist with a strong background in wound care billing, coding audits, and full-cycle claim management. This position is fully remote, offers flexible scheduling, and presents significant growth potential as SMWC expands its provider network and payer contracts. Position Summary This independent contractor role is responsible for managing the entire billing and coding cycle — from documentation audit and code verification to claim submission, monitoring, and payment reconciliation. You’ll ensure compliance with Palmetto MAC LCD guidelines and payer-specific wound care documentation requirements while optimizing reimbursement accuracy. Key Daily Responsibilities Chart Review & Documentation Audit • Audit wound care charts in Intellicure EHR to ensure documentation is complete, compliant, and supports billed services. • Verify that chart notes, procedure details, and wound measurements align with Palmetto MAC LCDs and industry best practices for mobile wound care. • Confirm presence of all required elements (e.g., HPI, wound characteristics, treatment details, time spent, provider signatures). • Communicate with the provider to correct or complete documentation when necessary before billing. Coding Validation & Compliance • Review and confirm all CPT, HCPCS, and ICD-10 codes assigned by Intellicure’s AI Coding Tool. • Correct or append codes, modifiers, and diagnosis links to ensure accuracy and compliance. • Validate coding for: • Debridement (11042–11047) • Skin substitutes and grafts (Q4205–Q4303, etc.) • Negative pressure wound therapy (NPWT) (97605–97606) • E/M codes for patient encounters • And other relevant procedural codes • Stay current on LCD updates, NCCI edits, MUE thresholds, and documentation requirements specific to Palmetto MAC and other payors. Claim Preparation & Submission • Build and prepare claims directly within the Intellicure Billing Portal. • Verify claim completeness, attachment requirements, and payer-specific formatting. • Submit claims electronically through EDI Insights by Waystar (Clearinghouse). • Ensure all claims meet payer submission deadlines and are transmitted successfully. Claim Monitoring, Denials, & Follow-up • Monitor claim acceptance, rejections, and payment statuses within Waystar (EDI Insights). • Research and resolve claim denials or underpayments promptly, including: • Reviewing EOBs/ERAs for denial reasons. • Initiating appeals or corrections. • Completing IVR or portal-based follow-ups as needed. • Track outstanding accounts receivable and escalate chronic issues to leadership. Communication & Reporting • Provide regular updates to SMWC leadership on: • Claim submission volumes and acceptance rates. • Denial trends and reasons. • Payment timelines and outstanding balances. • Maintain organized billing records and audit trails within Intellicure and Waystar systems. • Collaborate with leadership to identify workflow or documentation improvements that reduce denials and improve reimbursement efficiency. Preferred Qualifications • 3+ years of experience in medical billing and coding, including 1–2 years in wound care or outpatient specialty. • Strong working knowledge of Medicare, TennCare, Cigna, Humana, BCBS, UHC Wellcare, and Aetna billing guidelines. • Hands-on experience with Intellicure EHR and Waystar (EDI Insights) preferred. • Deep understanding of Palmetto MAC LCDs (L39760, L35041, L35125) and wound care compliance requirements. • Ability to interpret and apply NCCI edits, MUE limits, and CPT/HCPCS documentation standards. • Excellent written communication and problem-solving skills. • Proven ability to work independently in a remote environment while meeting deadlines and maintaining accuracy. Bonus if you have: • CPC, COC, or CCS certification strongly preferred. • Experience with mobile wound care or home-based specialty care billing. • Familiarity with Medicare Advantage and secondary claim submission workflows. Compensation & Terms • Type: 1099 Independent Contractor • Location: 100% Remote (U.S.-based) • Hourly Rate: $25 – $40 per hour, depending on experience and credentials • Hours: Flexible; We are in a growth phase so hours will be low to start but as volume increases we anticipate this role to become full time. • Incentives: Potential for rate increases or bonuses tied to accuracy, timeliness, and claim recovery performance. Should this individual prove to be dynamic and successful there is room for high internal growth within the company Why Join SMWC This is a hands-on opportunity to join a fast-growing, mission-driven healthcare company where your expertise directly drives operational and financial success. As an early member of our revenue operations process, you’ll have the autonomy to build efficient workflows and the potential to grow into a leadership role as our provider network expands. If you’re an experienced wound care billing professional who values precision, independence, and growth — we’d love to work with you! Job Types: Full-time, Part-time Pay: $25.00 - $40.00 per hour Expected hours: 5 – 20 per week Benefits: • Flexible schedule Application Question(s): • Do you have experience working within Intellicure • Do you have experience specifically in wound Care coding, billing, and claims managements? • Are you familiar with LCD guidelines related to Skin substitutes, specifically in regards to preceding treatment and documentation requirements? Work Location: Remote Apply tot his job