Billing​/Coding Specialist

Overview

US-CA-Oceanside Tri-City Medical Center has served San Diego County’s coastal communities of Carlsbad, Oceanside and Vista, as well as the surrounding region for more than 60 years and is one of the largest employers in North San Diego County. Tri-City is administered by the Tri-City Healthcare District, a California Hospital District. As a full-service acute care public hospital with over 500 physicians practicing in over 60 specialties, Tri-City is vital to the well-being of our community and serves as a healthcare safety net for many of our citizens.

The hospital has received a Gold Seal of Approval® from the Joint Commission showcasing a commitment to safe and effective patient care for the residents of the community. Tri-City Medical Center prides itself on being the home to leading orthopedic, spine and cardiovascular health services while also specializing in world-class robotic surgery, cancer and emergency care. Tri-City’s Emergency Department is there for your loved ones in their time of need and is highly regarded for our heart attack and stroke treatment programs.

When minutes matter Tri-City is your source for quality compassionate care close to home. Tri-City partners with over 90 local non-profit and community organizations as part of our COASTAL Commitment initiative. Together we are helping tackle some of our communities’ pressing health and social needs.

Is responsible for determining accurate codes for physician’s diagnoses and procedures. Keeps up-to-date with the latest medical compliance and reimbursement policies. Reviews medical record information to identify all appropriate coding, ensuring that it is compliant with the latest reimbursement policies and CMS guidelines. Generates invoices to be sent to insurances and to patients. Sorts and files paperwork, handles insurance claims and performs collections duties.

This position will work with the practice patients and clinical teams to accurately and completely code and prepare charges to be sent out for the patient’s visit.

The position characteristics reflect the most important duties, responsibilities and competencies considered necessary to perform the essential functions of the job in a fully competent manner. They should not be considered as a detailed description of all the work requirements of the position. The characteristics of the position and standards of performance may be changed by TCMC with or without prior notice based on the needs of the organization.

• Maintains a safe, clean working environment, including unit based safety and infection control requirements.
• Coding
  • Utilizes EHR for any documentation needed to support coding of a claim
  • Efficiently assigns ICD-10-CM, CPT-4 and HCPCS codes for surgeries from documentation based on the most current guidelines
  • Reviews note prepared by physician and ensures that no mistakes are made in those notes
  • Contacts physician if information is missing and gets the information filled in and/or corrected
  • Makes sure all medical record files are complete (including timed, dated, and signed)
  • Assigns modifiers based on payor guidelines
  • Understands documentation and compliance requirements for assigning of codes
  • Maintains strictest confidentiality and follows HIPAA guidelines for protecting Protected Health Information (PHI)
• Insurance/Patient Billing
  • Processes and submits electronic claims
  • Corrects electronic rejection edits
  • Ensures all NCCI edits are resolved within 2 business days to ensure claims are submitted within 5 days from service date
  • Prints paper claims as needed
  • Provides cash quotes for self-pay surgeries
  • Quotes and collects cash for non-covered procedures and injections
• Audits
  • Follows up to see if claim is accepted or rejected
  • Investigates rejected claim to see why denial was issued
• Performs other duties as assigned

• Minimum of 1 year of experience in health care.
• Demonstrates a good working knowledge of medical terminology, human anatomy and coding methodology.
• Possesses moderate knowledge of Level 1 & 2 modifiers.
• Ability to examine documents for accuracy and completeness.
• Detail oriented with ability to identify and…