Medical Billing & Coding Specialist

Position Type
:
Full Time

Shift
:
Day

Under general supervision of the Director of Finance, provides a variety of medical billing and coding duties for a variety of our medical programs (Redwood Coast PACE, Cal Aim, Behavioural Health Services) according to departmental, professional, and regulatory standards. Works collaboratively with specific program teams to ensure appropriate agencies, reports, policies, and procedures are engaged and to successfully enroll and dis-enroll participants as appropriate.

• Processes medical encounters to ensure coding and documentation are in place.
• Performs comprehensive review of documentation and other records to ensure documentation, signatures, dates, results, and other documents are complete. Work with the appropriate program team if any documentation is missing or inaccurate.
• Review encounters to ensure all coding is supported and in compliance with the payer's coding and billing requirements or reassigns per documentation.
• Coordinates with the Third-Party Administrator (TPA), if applicable, to track claims and ensure that primary payer sources have been identified and contacted.
• For programs that do not utilize a TPA, submit claims for processing and payment via the applicable billing system.

• Two years of medical billing and coding experience required.
• A combination of training and experience equivalent to an AS/AA degree in Accounting or Business Administration is preferred.
• Proven experience processing receivables and performing general accounting functions.

• Must possess one of the following certifications:
  Certified Billing and Coding Specialist (CBCS), Certified Professional Coder (CPC), Certified Professional Biller (CPB), Certified Coding Associate, and Certified Medical Reimbursement Specialist (CMRS). Additional experience can be substituted for certification requirements.