Medical Billing and Coding Specialist

About Us:

Coastal Gateway Health Center, Inc. (CGHC) is a new-start community health center that was formed in January 2022. The health center received startup funding for the project from the Winnie-Stowell Hospital District based on a feasibility study conducted in late-2021 that demonstrated a need for quality primary healthcare services in the area. The health center recently submitted its application to become a Federally Qualified Health Center Look Alike (FQHC LAL) application. CGHC is dedicated to providing high-quality, comprehensive healthcare services to our community in a caring and personal manner regardless of ability to pay.

Please visit our website at www.coastalgatewayhc.org for more information on the history of our organization.

Position Summary Statement:

The Coding and Billing Specialist supports the mission of the health center by ensuring accurate chart document, proper coding, and timely filing of third-party insurance claims. The Coding and Billing Specialist works collaboratively with all internal and external customers in compliance with each of the health center’s core values.

Responsibilities:

Coding and Charge Entry

• Monitor, maintain and actively work the health center’s work queues in a timely manner to resolve registration, coding and claim errors to ensure the health center’s timely submission of claims to insurance companies.
• Review each progress note to ensure coding accuracy based on the most current ICD/CM guidelines. All charts should be coded within 2-3 business days of the patient’s visit.
• Query the medical provider and add any necessary charges and modifiers for accurate billing, within 2-3 days of patient’s visit.
• After reviewing the progress note(s), communicate with providers to lock their encounters in the Electronic Medical Record (EMR).
• Notify the supervisor for any accounts that over five (5) days old or when a medical provider is non-responsive to queries.
• Act as an encounter coding resource to health center provider and support staff.
• Ensure optimal charge capture for all billable claims.
• Documentation reviews and chart scrubbing, updates patient financial messaging in EMR, as needed.
• Notify supervisor for identified workflow issues (or EMR template issue) that may be effecting coding/billing operations.

Revenue Cycle Management

· Act as the lead liaison between the health center and the external billing company on additional queries to providers, claim scrubbing, or claim denials.

· Be able to interface with health center leadership, external billing company, external consultants, and payors, as needed, to answer questions and resolve issues involving patient accounts receivable.

• Participates in annual financial audits, working with auditors to provide necessary documentation and review.
• Assists with maintaining accurate and current insurance codes and pricing used for clinic fee schedule (Chargemaster). Including conducting an annual Chargemaster review and update, as needed. Assists with preparing report for the Board of Directors annual review and approval.

· Be familiar with all aspects of the Revenue Cycle Management process for the health center, including billing, collection, collections, accounts receivable, aging reports, denials, and authorizations.

• Assists with reviewing accounts and providing recommendations for collection referrals to CEO and CFO for approval.

· Assist with providing education to clinical staff members regarding coding and billing and documentation.

Miscellaneous

• Intermediate to advanced knowledge of the Electronic Medical Record (EMR) system.
• Maintain effective communication with internal staff and external vendors.
• Works closely with the CEO, CFO, external billing company, and at times, external consultants.
• Performs other job-related duties as assigned.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.

EDUCATION/EXPERIENCE:

• High school or GED required, college education preferred.
• Education requirement may be waived based on work experience.

3. Two (2) to five (5) years of experience in an outpatient, primary care, community health center, preferred.

• Coding experience; CPC Certification preferred.
• Other preferred certifications, include, CRHCP, CMC, CMOM, or CMIS.
• Experience with billing, coding, and patient reception services in a healthcare setting preferred.
• Thorough working knowledge of federal, state, and local regulations governing the operation of a healthcare facility.
• High degree of health administration knowledge with special understanding of the problems and techniques of rural and multi-cultural healthcare delivery.

SKILLS/ATTRIBUTES

1. Advanced knowledge of electronic medical record (EMR) systems.

2. Knowledge of CPT, HCSPC, and ICD-10 CM coding systems.

3. Medical billing experience and understanding of FQHC billing.

4. Exceptional customer service skills.

5. Phone and communication skills.

6. Patient accounts receivable collections understanding and skills.

7. Ability to pay close attention to detail and to ensure accuracy of reports and data.

8. Ability to work effectively with a multidisciplinary team.

9. Demonstrates interpersonal competencies such as problem-solving, negotiation, and conflict management.

10. Active listener who is interested in being part of a collaborative and patient-centered team.

11. Ability to adapt to a fast-paced and rapidly changing work environment by prioritizing multiple tasks to perform efficiently and effectively.

12. Recognize, respect, and work effectively with people from diverse social, cultural, and ethnic backgrounds who may have different healthcare preferences and needs.

• Strong public relations and networking capabilities; proven ability to establish relationships and work with collaborative partners.
• Exceptional written, oral, and presentation skills.
• Demonstrated leadership skills.

Pay: $17.42 - $27.80 per hour

Ability to Commute:

• Winnie, TX 77665 (Preferred)

Ability to Relocate:

• Winnie, TX 77665: Relocate before starting work (Preferred)

Work Location: Hybrid remote in Winnie, TX 77665

Salary : $17 - $28