Billing and Coding Specialist I

Job Description

Job Description

Community health is about more than just vaccines and checkups. It’s about giving people the resources they need to live their best lives.

At Neighborhood, this is our vision : a community where everyone is healthy and happy. We’re with you every step of the way, with the care you need for each of life’s chapters.

At Neighborhood, we are Better Together.

As a private, non-profit 501(C) (3) community health organization, we serve over 506,563 medical, dental, and behavioral health visits from more than 96,867 people annually.

We do this in pursuit of our mission to improve the health and happiness of the communities we serve by providing quality care to all, regardless of situation or circumstance.

Since 1969, our employees have been making this mission a reality. Regardless of the role, our team focuses on being compassionate, having integrity, being professional, always collaborating, and consistently going above and beyond.

If this sounds like an organization you would like to be a part of, we would love to meet you.

The Billing and Coding Specialist I works to support the mission and vision of Neighborhood Healthcare by reviewing and validating patient chart billing codes.

Primary responsibilities for this role include generating audit reports on chart reviews performed, designing effective billing compliance trainings for clinical staff, and following through on critical timelines for compliance purposes.

Responsibilities

• Ensures timely and accurate processing of claims in a manner that is consistent with healthcare industry best practices
• Researches, abstracts, and communicates federal, state, and payer documentation, billing and coding rules and regulations
• Stays current with Medicare, Medi-Cal and other third-party rules and regulations including public programs such as FPACT, CPT updates, and ICD coding
• Serves as a liaison between billing staff and providers
• Performs scheduled and unscheduled independent chart reviews to ensure billing compliance of professional services billed through Neighborhood Healthcare, including eligibility, accuracy and adequacy of documentation, and coding related to FQHC and program billing
• Ensures billing and coding compliance with industry standards, regulations, and company policy and procedures
• Ensure charge capture are accurate and submitted in a timely manner
• Responsible for making sure all claims have the appropriate documentation after being coded and claims submitted, follow-up with teams on insufficient documentation
• Assists department with research of claims not paid and other duties assigned
• Reviews medical chart notes and encounters for accuracy in CPT, HCPCS, ICD10 coding
• Works on special temporary billing projects and claim filing as needed
• Documents all communications and activities in billing and financial notes to assist with clear, concise, and accurate communication to all who work with patients billing ledgers and processes
• Identify error trends or missed coding opportunities and use as an educational tool for the provider(s)
• Assists the compliance program with federal, state and other special investigations and chart reviews.

Qualifications

Education / Experience

• High school diploma / GED required; bachelor’s degree in healthcare preferred
• Current Certified Coding Specialist (CCS), Certified Procedural Coder (CPC) required
• Six months' CPT, ICD-10 coding systems, and chart review experience preferred
• Experience educating healthcare providers regarding coding, charting, and other relevant processes is preferred

Additional Qualifications(Knowledge, Skills and Abilities)

• Excellent verbal and written communication skills, including superior composition, typing and proofreading skills
• Ability to interpret a variety of instructions in written, oral, diagram, or schedule form
• Knowledgeable about and experience with Federally Qualified Health Center practices and programs
• Knowledge and understanding of electronic practice management systems and OIG billing and coding guidelines
• Knowledge and understanding of third-party payer contracts, Medi-Cal reimbursement, provider enrollment, HIPAA privacy, security rules, and compliance
• Ability to successfully manage multiple tasks simultaneously
• Excellent planning and organizational ability
• Ability to work as part of a team as well as independently
• Ability to work with highly confidential information in a professional and ethical manner

Pay range : $27.75-$34.00 per hour, depending on experience