Accredited CPC Medical Coding Specialist

Accredited CPC Medical Coding Specialist

Anza, CA $52,089 - $67,099 a year

Full Time

This role is responsible for accurately assigning codes to physician diagnoses and procedures, ensuring compliance with the latest medical billing and reimbursement policies. The specialist reviews medical records to identify all appropriate coding, adhering to CMS guidelines and current reimbursement standards. Duties include generating invoices for insurance and patient billing, managing paperwork, handling insurance claims, and performing collections. Collaboration with clinical teams and patients is essential to ensure precise and complete charge preparation for each visit.

• Maintain a safe and clean work environment, following unit safety and infection control protocols.
• Coding:
  • Utilize electronic health records (EHR) to support claim coding.
  • Assign ICD-10-CM, CPT-4, and HCPCS codes for surgeries based on current guidelines.
  • Review physician notes for accuracy and completeness.
  • Communicate with physicians to clarify or correct documentation as needed.
  • Ensure all medical records are complete, including proper timing, dating, and signatures.
  • Apply modifiers according to payer guidelines.
  • Understand documentation and compliance requirements for code assignment.
  • Maintain strict confidentiality and comply with HIPAA regulations protecting patient information.
• Insurance and Patient Billing:
  • Process and submit electronic claims efficiently.
  • Resolve electronic claim rejections promptly.
  • Address NCCI edits within two business days to ensure timely claim submission.
  • Print paper claims when necessary.
  • Provide cash quotes for self-pay surgeries and collect payments for non-covered procedures and injections.
• Auditing:
  • Follow up on claim acceptance or rejection.
  • Investigate reasons for claim denials and take corrective action.
• Perform additional duties as assigned.

• At least one year of healthcare experience.
• Strong knowledge of medical terminology, human anatomy, and coding methodologies.
• Moderate understanding of Level 1 and 2 modifiers.
• Ability to review documents for accuracy and completeness.
• Detail-oriented with problem-solving skills.
• Knowledge of NCCI, CCI edits, and LCDs with the ability to apply regulations accurately.
• Effective communication skills and ability to collaborate with coworkers.
• High ethical standards and professional integrity.
• Strong analytical and persuasive communication skills at all organizational levels.

• High school diploma or GED required.
• Certificate or diploma from an accredited medical coding program.

• Current CPC, CPC-A, CCS, or RHIT certification required.

Successful candidates must pass a physical exam, drug screening, and background checks prior to employment. This position is located in a regional healthcare setting within the Pacific Northwest.