Under general direction, this position provides billing and coding support within the Ambulatory Care Clinic System, with specialization in ENT, plastic reconstruction, neurology, and urology.
This role serves as a bridge between the Medical Billing Specialist series and the Coder-Certified classification. The position focuses on reviewing the accuracy of billing codes entered by providers, validating coding and billing data, supporting reimbursement workflows, and assisting with audits, training, and denial prevention.
Requirements & Qualifications
Qualifications
- Seven years of hands-on experience performing professional medical coding and/or billing duties in a comparable medical system or high-volume outpatient surgical specialty clinic.
- Previous paid, professional billing and coding experience in a surgical environment.
- Must possess and maintain at least one of the following credentials:
- Certified Coding Specialist (CCS)
- Certified Professional Coder (CPC)
- Certified Coding Specialist-Physician (CCS-P)
- Associate's or bachelor's degree in a business-related field is desired.
Knowledge and Skills
- Surgical specialties including otolaryngology (ENT), plastic reconstruction, urology, and neurology.
- Surgical terminology and operative report structures.
- CPT, ICD-10, and HCPCS coding systems.
- Medical reimbursement programs and payment systems.
- Medi-Cal Provider Manual billing and policy requirements.
- Treatment Authorization Request (TAR) process.
- Authorization requirements for private health plans and county health plans.
- Ability to interpret operative reports and surgical documentation.
- Ability to review accounts for appropriate documentation, coding, and billing information.
- Ability to identify compliance and audit issues and work with compliance staff to resolve regulatory conflicts.
Benefits & Perks
Compensation and Perks
- Educational incentive may be available for eligible incumbents based on completion of an Associate's, Bachelor's, or Master's degree.
- Bilingual incentive may be available depending on operational need and certification of skill.
- Regular, temporary, fixed-term, intermittent, and extra-help vacancies may be filled from the eligible list.
Location
California, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
No
Posted
4 months ago