Medical Billing and Coding Specialist
2 days ago
Job Summary
The Billing and Coding Specialist is responsible for ensuring the accurate and compliant coding and billing of all medical, dental, vision and behavioral health services within a Federally Qualified Health Center (FQHC). This position plays a vital role in supporting revenue cycle operations by accurately translating medical documentation into billable codes and ensuring timely submission of claims to various payers including Medicare, Medi-Cal, commercial insurances, and Managed Care Organizations (MCOs). Additionally, this dual role integrates claims processing and eligibility interpretation responsibilities, with regular use of tools such as MedPoint, DHCS, and health plan portals, in addition to eClinicalWorks (eCW) for billing workflows.
Key Responsibilities
Medical Coding & Documentation Review
- Accurately assign ICD-10, CPT, and HCPCS codes to clinical encounters across service lines.
- Apply appropriate FQHC-specific billing codes (T1015, G0466–G0470) and modifiers.
- Audit provider documentation for coding integrity; query providers when clarification is needed.
Claims Processing & Charge Entry
- Review and validate encounter charges in eClinicalWorks (eCW).
- Submit clean claims to clearinghouses and correct any claim or edit rejections promptly.
- Monitor billing work queues and clearinghouse dashboards to ensure no delays.
Eligibility Interpretation & Portal Usage
- Interpret coverage and aid codes using MedPoint, DHCS portal, and payer websites (e.g., IEHP, LA Care, Availity).
- Confirm eligibility for self-pay, Medi-Cal, and third-party payers prior to claim submission.
- Work with front office and billing staff to resolve eligibility mismatches or demographic errors.
Denial Prevention & Resolution
- Analyze claim denials related to coding, eligibility, or system errors.
- Take corrective action to recode and resubmit denied claims.
- Document trends and escalate recurring issues to management.
Compliance & Audit Support
- Maintain adherence to CMS, HRSA, UDS, HEDIS, and payer-specific coding guidelines.
- Support audit requests, OSV preparation, and internal quality reviews.
- Apply Sliding Fee Discount Program guidelines when applicable.
Skills
- Proficiency in ICD-10, CPT, and HCPCS coding.
- Knowledge of FQHC billing practices, including PPS, UDS, and HEDIS.
- Comfortable working in eClinicalWorks (eCW) EHR system.
- Skilled in interpreting MedPoint, DHCS, and payer eligibility portals.
- Familiarity with payer rules for Medi-Cal (FFS and MCOs), Medicare, and commercial insurance.
- Strong attention to detail, time management, and organizational skills.
- Ability to troubleshoot independently and communicate effectively across teams.
Education & Experience
- High school diploma or GED required; Medical Billing Certification preferred.
- Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) is preferred.
- Minimum 2 years of experience in medical billing and/or coding, preferably in an FQHC or community health setting.
- Familiarity with California-specific Medi-Cal programs is a plus.
This position offers an opportunity to work within a dynamic healthcare environment where precision, compliance, and efficiency are valued. Candidates with prior experience in medical office settings or healthcare administration are encouraged to apply.
Job Type: Full-time
Pay: $ $22.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Tuition reimbursement
- Vision insurance
Work Location: In person
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