The RCM Biller/Coder is responsible for accurate coding and billing of professional services to ensure timely, compliant, and clean claim submission across all affiliate sites. This role supports Athena and Epic workflows and applies current CPT, ICD-10-CM, and HCPCS coding guidelines in alignment with Rancho Family MSO Revenue Cycle Management policies and payer requirements.
The role works collaboratively with RCM leadership and team members to resolve coding issues, address denials, and support optimal revenue cycle performance.
Essential duties include:
- Accurately assign CPT, ICD-10-CM, and HCPCS codes based on provider documentation and established coding guidelines
- Code and bill claims in a timely manner to support clean claim submission and optimal first-pass resolution rates
- Manage assigned coding and billing work queues in Athena and Epic in accordance with established workflows and productivity standards
- Identify documentation gaps or inconsistencies and route for clarification or correction as appropriate
- Review and assist in resolving coding-related denials, medical necessity issues, and payer rejections
- Follow up on unpaid or denied claims requiring coding review to support prompt resolution and reduce rework
- Respond to internal billing and coding inquiries within defined escalation pathways
- Maintain compliance with payer policies, regulatory requirements, and internal RCM standards
- Stay current on coding updates, payer policy changes, and regulatory guidance relevant to assigned specialties
- Participate in team meetings, training sessions, and quality improvement initiatives
- Adhere to standardized workflows and documentation practices within Athena and Epic systems
- Perform other duties as assigned
Requirements & Qualifications
Required education and experience:
- High school diploma or equivalent required
- Associate or bachelor’s degree in Health Information Management or a related field preferred
- Current coding certification required (CPC, CCS, or equivalent)
- 2–4 years of medical billing and/or coding experience required
- Experience in a multi-specialty and/or multi-site environment preferred
- Prior experience working in Athena and/or Epic required
- Experience supporting denial resolution and claim follow-up preferred
Required knowledge and skills:
- Working knowledge of CPT, ICD-10-CM, and HCPCS coding standards
- Understanding of payer requirements, claim submission processes, and denial workflows
- Strong attention to detail and commitment to accuracy
- Ability to manage assigned workloads and meet productivity and quality expectations
- Effective written and verbal communication skills
- Ability to work independently while collaborating within a team environment
- Proficiency navigating Athena and Epic billing and coding workflows
- Strong organizational and time-management skills
Location
California, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
4 weeks ago