Summary:

Reviews patient medical charts and documents to translate diagnoses, procedures, and services into universal codes for billing, insurance reimbursement, and data tracking. Core responsibilities include analyzing patient records, assigning the correct codes according to medical coding systems such as CPT and ICD-10, communicating with physicians to clarify documentation, and ensuring compliance with coding guidelines to prevent claim denials. This role is responsible for processing claims in a timely manner and managing assigned work queues to adhere to health center and Ochin EPIC best practices.

This position is responsible for recovering costs for medical care by billing patients, insurers, third-party payers, or various medical aid programs. Also, may perform complex technical accounting assignments generally related to medical billing. This position will navigate complex PPS/APM payment models while maintaining compliance with state and federal healthcare mandates.

On-site work is expected at AMC’s Healdsburg or Windsor health centers; some remote work may be available, provided that billing metrics and attendance meet company expectations.

Some Essential Duties and Responsibilities:

· Work with billing teams and providers to ensure accurate and timely submission of insurance claims to facilitate proper reimbursement.

· Complete daily work queue resolution to process claims assigned for research, follow-up, or resubmission.

· Contact physicians and other healthcare providers to clarify any documentation deficiencies or ask questions regarding diagnosis and treatment.

· Correct codes according to CPT, ICD-10, and HCPCS guidelines.

· Prepares and analyzes regular billing performance and status reports for leadership review

Qualifications:

The requirements listed below are representative of the knowledge, skills, and/or abilities required to successfully perform the duties of the position.

Education and/or Experience:

· Associate's degree preferred; high school degree or equivalent required.

· Billing Certifications and 3 years of related biller/coder experience required.

· Familiarity with EPIC, clearinghouse software, and Microsoft Office, including intermediate-advanced Excel, required.

· Experience coding for FQHC integrated behavioral health or dental services, required.

· 2+ years of experience as a certified coder working with California FQHC’s (Federally Qualified Health Centers), Medicaid, and Medicare billing, and private insurance required. 

· Experience working in a fast-paced, cross-functional medical practice, preferred.

· Must be a self-starter and able to work in a fast-paced, deadline-driven environment.

· Equivalent combination of education and relevant experience may be considered.

Certificates, Licenses, Registrations:

· Current and valid state licensure as CPC, CPMA, CRC, CCS, or CDEO.

Skills and Abilities:

· Advanced proficiency with coding systems such as CPT, ICD-10, and HCPCS

· Medical terminology: a strong understanding of medical terminology is crucial for accurately interpreting clinical documentation

· Anatomy and physiology: knowledge of the human body and how diseases and conditions work.

· Attention to detail: The ability to focus and accurately process large amounts of detailed information.

· Active OCHIN Epic resolute billing or ambulatory coding proficiency.

· Computer skills: Familiarity with medical classification software, preferably EPIC, and other office 

· Certification as Medical Coder (CPCP or Certified Coding Specialist (CCS) designation.