Coding Compliance Specialist jobs in San Diego, CA

Community health is about more than just vaccines and checkups. It’s about giving people the resources they need to live their best lives. At Neighborhood, this is our vision. A community where everyone is healthy and happy. We’re with you every step of the way, with the care you need for each of life’s chapters. At Neighborhood, we are Better Together.

As a private, non-profit 501(C) (3) community health organization, we serve over 350k medical, dental, and behavioral health visits from more than 77k people annually. We do this in pursuit of our mission to improve the health and happiness of the communities we serve by providing quality care to all, regardless of situation or circumstance.

We have been doing this since 1969 and it is our employees that make this mission a reality.  Regardless of the role, our team focuses on being compassionate, having integrity, being professional, always collaborating, and consistently going above and beyond.  If that sounds like an organization you want to be a part of, we would love to have you.

The Billing and Coding Specialist works to support the mission and vision of Neighborhood Healthcare by reviewing and validating patient chart billing codes.  Primary responsibilities for this role include generating audit reports on chart reviews performed, designing effective billing compliance trainings for clinical staff, and following through on critical timelines for compliance purposes.

Responsibilities

• Ensures timely and accurate processing of claims in a manner that is consistent with healthcare industry best practices
• Researches, abstracts, and communicates federal, state, and payer documentation, billing and coding rules and regulations
• Stays current with Medicare, Medi-Cal and other third-party rules and regulations including public programs such as FPACT, CPT updates, and ICD coding
• Serves as a liaison between billing staff and providers
• Performs scheduled and unscheduled independent chart reviews to ensure billing compliance of professional services billed through Neighborhood Healthcare, including eligibility, accuracy and adequacy of documentation, and coding related to FQHC and program billing
• Develops, implements, and consistently seeks improvement in policies and procedures for all billing and reimbursement functions to ensure department activities are carried in accordance with industry standards and optimizes revenue
• Develops and provide New Provider Orientation Billing and Coding training to new team members
• Ensures billing and coding compliance with industry standards, regulations, and company policy and procedures
• Ensure charge capture are accurate and submitted in a timely manner
• Responsible for making sure all claims have the appropriate documentation before being coded and claims submitted; follow-up with teams on insufficient documentation
• Assists department with research of claims not paid and other duties assigned
• Reviews medical chart notes and encounters for accuracy in CPT, HCPCS, ICD10 coding
• Posts charges & payments as needed
• Works on special temporary billing projects and claim filing as needed
• Documents all communications and activities in billing and financial notes to assist with clear, concise, and accurate communication to all who work with patients billing ledgers and processes
• Identify error trends or missed coding opportunities and use as an educational tool for the provider(s)
• Assists with annual superbill review and update with CPT and ICD-10 codes
• Works collaboratively with the appropriate operational leaders to develop provider education strategies to promote complete and accurate clinical documentation and non-compliance trends
• Develops chart review tool(s) to track and monitor chart review outcomes. Summarizes outcomes and reports them to the Director and/or the Management team(s)
• Assists the compliance program with federal, state and other special investigations and chart reviews.
• Other duties as assigned

Education/Experience

• High school diploma/GED required; bachelor’s degree in healthcare preferred
• Two years of CPT, ICD-10 coding systems, and chart review experience or equivalent combination of education and experience is required
• Current Certified Coding Specialist (CCS), Certified Procedural Coder (CPC) or equivalent is required
• Experience educating healthcare providers regarding coding, charting, and other relevant processes is preferred

Additional Qualifications (Knowledge, Skills and Abilities)

• Excellent verbal and written communication skills, including superior composition, typing and proofreading skills
• Ability to interpret a variety of instructions in written, oral, diagram, or schedule form
• Knowledgeable about and experience with Federally Qualified Health Center practices and programs
• Knowledge and understanding of electronic practice management systems and OIG billing and coding guidelines
• Knowledge and understanding of third-party payer contracts, Medi-Cal reimbursement, provider enrollment, HIPAA privacy, security rules, and compliance  
• Ability to successfully manage multiple tasks simultaneously
• Excellent planning and organizational ability
• Ability to work as part of a team as well as independently
• Ability to work with highly confidential information in a professional and ethical manner

Neighborhood Healthcare requires employees to be fully vaccinated (including a booster dose) against COVID-19 and demonstrate proof of vaccination/booster upon hire or receive approval for an exemption based on a medical reason, disability or religious belief.  Proof of booster dose will be contingent upon booster eligibility.   

Pay Range: $28.09 to $34.33 per hour, depending on experience.