{ "schema": "aiblocks-page/1", "id": "agency-medical-billing-coding-specialist", "type": "agent", "name": "Medical billing and coding specialist", "summary": "Check medical coding and claims against the visit notes, triage denials and draft appeal letters. A certified coder signs off before you submit.", "headline": "Medical billing and coding specialist", "subhead": "Paste de-identified visit notes with the codes billed, or a denial notice. Your AI checks each code against what the notes support, lists missing documentation, and drafts an appeal letter with blanks for patient details. It is a second pair of eyes, not a final coder.", "job": { "id": "document-work", "name": "Write down how work gets done" }, "level": "intermediate", "thinking": "high", "tested": true, "updated": "2026-11-03", "first_published": "2026-10-26", "inputs": [ { "type": "document", "required": true, "label": "Document", "what": "a finished document, such as a Word file, a PDF or a page of notes" }, { "type": "question", "required": false, "label": "Question", "what": "the problem, decision or piece of work you want help with, and what a good outcome looks like" } ], "outputs": [ { "type": "audit_report", "required": true, "label": "Audit report", "what": "findings with evidence, severity, missing inputs and next actions" }, { "type": "document", "required": true, "label": "Document", "what": "a finished document, such as a Word file, a PDF or a page of notes" } ], "you_give": [ "Visit notes or an operative report, with patient name, date of birth, member ID and record numbers removed", "The codes and modifiers billed, or the codes you want checked", "The payer, the provider's specialty and the year of service", "The denial notice or reason codes, if this is a denial (optional)", "The payer's policy text for the service, if you have it (optional)" ], "you_get": [ "A table of each code, with what the notes support, the quote behind it and what to check", "A list of missing documentation and a plain question to send to the provider", "A pre-submission checklist marked pass, fail or not supplied", "A denial triage with the cause type, the deadline to look up and the next action (if a denial)", "An appeal letter draft with blanks for patient details (if a denial)", "A note on who must review it before anything goes to a payer" ], "use_when": [ "A provider asks if the notes support the E/M level or modifier they billed.", "A claim came back denied and you need to sort the cause and draft an appeal.", "You want a pre-submission checklist run on a batch of claims.", "You have KPI numbers, such as denial rate and days in accounts receivable, and want a plain readout of what they suggest." ], "skip_when": [ "You want the final code or claim approved. A certified coder or billing professional does that, using the current code books and the payer's policy.", "You want to reply to a patient about a bill or a question. Use the Patient service reply writer.", "You are building billing software or a payments integration. Use the Payments and billing engineer agent." ], "output_sample": { "input": [ "Visit notes with patient details removed", "The codes and modifiers billed, the payer, the specialty and the year", "A denial notice or reason codes (optional)", "The payer's policy for the service (optional)" ], "prerequisites": [ "Your practice's rules for using AI with patient data", "A certified coder or billing professional to review the result" ], "output": [ { "name": "Code review", "contains": "Each code or modifier with what the notes support, a quote, a status and what to check." }, { "name": "Documentation questions", "contains": "Plain questions for the provider where the notes do not support a code." }, { "name": "Claim checklist", "contains": "Demographics, provider, coding, linking and filing checks, each marked pass, fail or not supplied." }, { "name": "Denial triage", "contains": "The cause type, the deadline to look up and the next action for each denied claim." }, { "name": "Appeal letter draft", "contains": "A letter with blanks for patient details, the coding and clinical reasons, and an enclosures list." }, { "name": "Sign-off note", "contains": "A reminder that a certified reviewer must approve the work before it goes to a payer." } ] }, "output_shape": "BILLING REVIEW\n Job: \n Payer: | Specialty: | Year of service: | Supplied: \n\nCODE REVIEW\n | | | | \n\nDOCUMENTATION QUESTIONS FOR THE PROVIDER\n \n\nCLAIM CHECKLIST\n | \n\nDENIAL TRIAGE (if a denial)\n | | | | \n\nAPPEAL LETTER DRAFT (if asked)\n \n\nSIGN-OFF\n Not final. A certified coder or billing professional reviews this before it goes to a payer.", "how_to_use": [ "Protect patient data first. Remove names, dates of birth, member IDs and record numbers. Use this AI only in a way your practice's privacy rules allow.", "Add the pack as a skill, or paste SKILL.md and then references/source-agent.md into a new chat.", "Paste the notes, the codes billed, the payer, the specialty and the year. Say the job, such as \"Check these codes against the notes\" or \"Triage this denial and draft an appeal.\"", "Read the missing documentation list. Ask the provider to answer the questions. Do not code from guesses.", "Look up each code in the current code books, and read the payer's policy. The AI cannot confirm they are current.", "Have a certified coder or billing lead approve everything before you submit, appeal or refund anything." ], "checks": [ "The result addresses your actual task and cites the evidence used.", "Examples, role-play experience and targets are kept separate from verified results.", "Claims of tests, memory, tool access or completed actions match what actually happened." ], "next": [ { "name": "Project requirement tracker", "url": "https://useaiblocks.com/skills/project-requirement-tracker", "why": "Project requirement tracker" } ], "source": { "by": "Michael Sitarzewski and Agency Agents contributors", "repo": "msitarzewski/agency-agents", "url": "https://github.com/msitarzewski/agency-agents/blob/b37b5bb33b78f2c1d6567d98e25ca818e3259219/specialized/medical-billing-coding-specialist.md", "licence": "MIT", "original_name": "Medical Billing & Coding Specialist", "commit": "b37b5bb33b78f2c1d6567d98e25ca818e3259219" }, "credits": [ { "title": "Medical Billing & Coding Specialist", "by": "Michael Sitarzewski and Agency Agents contributors", "url": "https://github.com/msitarzewski/agency-agents/blob/b37b5bb33b78f2c1d6567d98e25ca818e3259219/specialized/medical-billing-coding-specialist.md", "used": "Original agent profile, preserved in references/source-agent.md; AI Blocks adds setup and review instructions." } ], "files": [ "LICENSE", "references/source-agent.md", "SETUP.md", "source.json" ], "links": { "page": "https://useaiblocks.com/agents/agency-medical-billing-coding-specialist", "markdown": "https://useaiblocks.com/agents/agency-medical-billing-coding-specialist.md", "json": "https://useaiblocks.com/agents/agency-medical-billing-coding-specialist.json", "instructions": "https://useaiblocks.com/skills/agency-medical-billing-coding-specialist/SKILL.md", "download": "https://useaiblocks.com/skills/agency-medical-billing-coding-specialist.zip", "api_item": "https://useaiblocks.com/api/v1/items/agency-medical-billing-coding-specialist", "api_document": "https://useaiblocks.com/api/v1/documents/agent/agency-medical-billing-coding-specialist", "mcp": "https://useaiblocks.com/mcp" } }