Job Description

Billing Medical Coder

The Billing Medical Coder is responsible for the day-to-day coding and billing operations for all services billable under grants, federal, state, and county programs including Medicare, Medi-Cal, managed care and private insurances. Starting Bonus: $5,000 Location: This role is located in Midtown - Sacramento, CA (95811). This role allows a hybrid schedule requiring 1-2 days per week on site.

Training Period: 46 weeks onsite, 5 days per week

Essential Functions

• Review and adjudicate coding of services from documentation in a timely manner.
• Code physician/provider visit procedure notes to identify appropriate ICD10 and CPT4 codes for charge processing.
• Ensures that all diagnosis ICD10 codes and procedure CPT, HCPCS codes are identified, sequenced, and coded in an accurate and ethical manner for optimized reimbursement.
• Assigns Evaluation and Management codes and key concepts/elements documented in the patient note, utilizing defined coding guidelines applicable to professional and technical standards
• Research and identifies correct codes for routine, and/or new or unusual diagnosis and procedures not clearly listed in ICD10 and CPT guidelines and functions of the position
• Identify all procedures that may require modifiers (including 340B) for billing and reporting.
• Query providers as needed - Consult with physician and providers for clarification of clinical data when encountering conflicting or ambiguous information and/or significant missing documentation.
• Track cases with insufficient documentation, ensuring the case does become appropriately coded and billed.
• Ensures documentation/coding meets Federal, State, County, and payer regulations and guidelines.
• Maintain knowledge of current guidelines, policies, ad regulatory updates (e.g., CMS, HIPPA)
• Participate in internal audits, compliance initiatives, and continuing education.
• Assist with claims submission and respond to coding-related denials and audits.
• Ensure coding productivity and accuracy standards are met or exceeded.
• Experience with EHR systems, coding software (e.g., Epic, EncoderPro)
• Excellent attention to details, analytical skills, and communication abilities

Additional Duties

• Provider Training - attend monthly provider meetings to advise providers of any changes to coding rules & regulations, field coding questions

Minimum Requirements

• Current CPC certification through AAPC or AHIMA, must be kept current and in good standing.
• Expertise in the following area, typically gained from 2 years of experience in medical coding.
• Comprehensive knowledge and understanding of medical coding including insurance payor guidelines, ICD1O, CPT Billing, E/M coding
• Ability to work in collaboration with the Billing Manager to provide clinician education on coding guidelines.
• Ability to analyze medical records in an Electronic Health Record system to identify documentation deficiencies and verify documentation supports diagnoses, procedures and treatments.

Preferred Background

• FQHC experience
• Ochin Epic or Epic experience
• Ability to collaborate effectively across a broad spectrum of backgrounds and perspectives. Candidates who demonstrate inclusive thinking and interpersonal awareness help strengthen our commitment to equitable and compassionate care for all.

Reasonable Accommodations One Community Health endorses and supports the Americans with Disabilities Act of 1990 (ADA) and the California Fair Employment and Housing Act (FEHA) and is committed to providing reasonable accommodations to qualified individuals with disabilities who are applicants or employees who need accommodations. If you require an accommodation due to a disability to complete this application or you are experiencing difficulty submitting your application, please contact us at ochhumanresources@onecommunityhealth.com.

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