Job Description

CERTIFIED MEDICAL CODER/BILLER –

PLEASE NOTE – YOU MUST BE CERTIFIED IN THE STATE OF CALIFORNIA TO BE CONSIDERED FOR THIS POSITION. THANK YOU!

Under the direction of the Chief Financial Officer (CFO), the Certified Medical Coder/Biller evaluates medical records and assigns appropriate clinical diagnosis and procedure codes in accordance with nationally recognized coding guidelines. This position has been identified as a safety sensitive position that includes tasks or duties (i.e., driving) that the employer in good faith believes could affect the safety, health or reputation of the Organization, participants, the employee performing the task or others.

Job Type: Full time (This position can be worked 100% remotely within the state of California)

FLSA Status: Hourly, Non-exempt

Reports to:  Chief Financial Officer

Essential Functions

• Analyzes medical information from medical records;
• Accurately codes diagnostic and procedural information in accordance with national coding guidelines and appropriate reimbursement requirements;
• Consults with medical clinicians to clarify missing or inadequate record information and to determine appropriate diagnostic and procedure codes;
• Provides thorough, timely and accurate assignments of ICD and/or CPT4 codes, MS-DRGs, APCs, POAs and reconciliation of charges;
• Abstracts clinical diagnoses, procedure codes and documents other pertinent information obtained from the medical record into the electronic medical records;
• Seeks out missing information and creates complete records, including items such as disease and procedure codes, point of origin code, discharge disposition, attending physician, consulting physicians, and appropriate signatures/authorizations;
• Refers inconsistent patient treatment information/documentation to coding quality analysis, supervisor or individual department for clarification/additional information for accurate code assignment;
• Provides quality assurance for medical records. for all assigned records and/or areas assures compliance with coding rules and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General (OIG) and the Health Care Financing Administration (HCFA), as well as company and applicable professional standards;
• Reviewing patient bills for accuracy and completeness with third-party billing vendor;
• Following up on unpaid claims within standard billing cycle timeframe with third-party billing vendor;
• Auditing insurance payments for accuracy and compliance with contract discount;
• Calling insurance companies regarding any discrepancy in payments if necessary;
• Participation in calls with third-party billing vendor;
• Working with DAP teams to ensure EMR and WQs are kept current and up to date;
• As assigned, compiles daily and monthly reports; tabulates data from medical records for research or analysis purposes;
• Routine and regular audit and review of medical claims for timely submission, accurate payment and denial remediation;
• Perform other job-related duties as assigned.

Required Education and Experience

• Graduate from a high school, or possession of a certificate of proficiency issued by the California State Board of Education, or possession of a G.E.D. certificate; plus 4 years medical coding experience;
• Must demonstrate a level of knowledge and understanding of ICD and CPT coding principles as recommended by the American Health information Management Association coding competencies, and as normally demonstrated by certification by the American Academy of Professional Coders;
• Must have working knowledge/familiarity to work effectively with common office software, coding software and abstracting systems;
• Understand and maintain confidentiality in accordance with Organization policies;
• Ability to work accurately and with minimal supervision;
• Ensure data and research are completed in a timely and procedurally correct manner;
• Ability and willingness to work with diverse populations;
• Willingness to work hours necessary to meet deadlines;
• Must obtain and maintain a Fingerprint clearance card and pass a background check.

Preferred Education and Experience

• Bilingual – English/Spanish
• Familiar with EPIC practice management software or other similar software
• Four or more years of experience providing coding services for a hospital, urgent care or a large family practice facilities
• Prior business office or medical records experience.

License(s) and Certification(s)

• Certification from an accredited medical coding certification organization (i.e., American Academy of Professional Coders; American Health Information Management Association).

Working Environment and Physical Demands

This job operates in an office set and requires frequent times of sitting, standing, repetitive motion, and talking. Ability to lift up to 24 pounds. No direct patient contact under normal circumstances is required. No exposure involvement to blood, body fluids, non-intact skin or tissue specimens required and no access to patient protected health information.

Other Duties

Please note that this job description is not designed to cover or contain a comprehensive listing of everything that is required of the employee for the job. Duties, responsibilities and activities may change at any time with or without notice.

Work Authorization/Security Clearance

This job requires full proof of authorization to work in the United States without any future requirement of sponsorship for work visa.

Affirmative Action Plan (AAP)/Equal Employment Opportunity (EEO) Statement

We are an Equal Opportunity Employer (EOE) and a Drug Free Workplace.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

How to Apply

Job Categories: Equal Opportunities. Job Types: Full-Time. Salaries: 40,000 - 60,000.

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