Job description

About Us
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.
Description
This job is located in the greater San Diego area however, you will be working remotely from home. You must be able to attend meetings in Escondido and surrounding areas.
The Billing and Coding Specialist for Neighborhood Healthcare (NHcare) will create, conduct and validate routine and focused chart reviews. Given the changing regulatory environment, priorities include identifying compliance risks, developing and following up on action plans and providing compliance education. The Billing Coding Specialist will focus on reviewing charts monitoring and coding compliance for NHcare. Responsibilities include generating reports on chart reviews performed, collaborating with staff to design effective training action plans following through on critical timelines to ensure implementation and performing of chart reviews as needed to verify ongoing billing compliance.
Essential Duties and Responsibilities

• Through direct efforts and coordination of other billing team efforts, ensure 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 NHcare, including eligibility, accuracy and adequacy of documentation and coding related to FQHC and program billing.

• Develop, implement, and consistently seek improvement in policies and procedures for all billing and reimbursement functions to ensure department activities are carried out professionally and ethically, and revenue is optimized.

• Develop and Provide New Provider Orientation Billing and Coding training

• Ensure 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.

• Assists department with research of claims not paid and other duties assigned.

• Review medical chart notes and encounters for accuracy in CPT, HCPCS, ICD10 coding

• Other additional duties as assigned.

Requirements
Skills: Demonstrated experience conducting medical records chart reviews and ability to interpret and apply Federal and State regulations, coding and billing requirements. Demonstrated ability to constructively and sensitively provide feedback to health center leadership regarding federal and state coding, medical documentation and compliance guidelines, audit results and risk areas. Ability to work with and maintain confidentiality of physician, patient, patient account and personnel data. Demonstrated ability to review analytical data and chart review findings to identify coding trends and other risk areas. Demonstrated ability to work independently with minimal direct supervision in the efficient and thorough completion of tasks. Demonstrated ability to prioritize multiple tasks, assignments and projects to meet established quality and time requirements. Demonstrated ability to work collaboratively and develop effective working relationships with a variety of individuals to gain support in the planning, design, and implementation of programs and services.
Education: **Current Certified Coding Specialist (CCS) or Certified Procedural Coder (CPC) or equivalent required. B.S./B.A. in healthcare or a related field preferred.
Experience: **At least two years of CPT, ICD-10 coding systems and chart review experience required. Experience preferred in educating providers regarding coding, charting and other relevant processes, in an individual and group setting required. Experience with Federally Qualified Health Center practices and programs preferred. Demonstrated experience with electronic practice management systems. Thorough understanding of third-party payer contracts, Medi-Cal reimbursement, provider enrollment, HIPAA privacy and security rules and compliance. Technology skills must include advanced level Excel, Access, and other MSOffice programs. Advanced working knowledge of CPT – 4 and ICD 10 coding requirements and OIG billing compliance guidelines.
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: $24.00 to $30.00 per hour, Depends on Experience (DOE)
Location: Escondido,California,92025,United States, Escondido, CA 92025

Location: Escondido,California,92025,United States, Escondido, CA 92025

Job Type: Full-time

Pay: $24.00 - $30.00 per hour

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