Rural Health Clinic Billing Coordinator PAH

Position Summary

The Rural Health Clinic (RHC) Billing & Coding Specialist is responsible for overseeing billing, coding, and compliance functions specific to Rural Health Clinics within the physician group. This role ensures accurate and timely claim submission, maximizes reimbursement under CMS and Medicaid RHC guidelines, and minimizes compliance risks. The specialist will serve as the central resource for all RHC start-ups, providing expertise in encounter-based billing, regulatory requirements, and process implementation. Additionally, the position will support knowledge transfer by training staff across the physician group to build internal capacity in RHC billing and compliance.

Key Responsibilities

• Billing & Coding Oversight
• • Accurately review and submit RHC claims in accordance with CMS, Medicaid, and commercial payer requirements.
  • Monitor encounter-based billing processes to ensure compliance with RHC reimbursement methodologies.
  • Resolve denials, rejections, and claim edits in a timely manner.
• Compliance & Regulatory Alignment
• • Ensure billing practices comply with RHC-specific CMS/Medicaid regulations.
  • Stay current with regulatory updates affecting RHC operations and communicate changes to leadership and staff.
  • Support internal audit readiness and assist with external audits as needed.
• RHC Start-Up & Implementation Support
• • Develop and implement billing workflows and processes for new RHC locations.
  • Collaborate with leadership, providers, and operational staff to ensure revenue cycle readiness from day one.
• Training & Knowledge Transfer
• • Train and mentor billing and coding staff on RHC-specific requirements.
  • Develop written guidelines, reference materials, and training sessions to expand organizational expertise.
• Performance Monitoring & Reporting
• • Track billing performance metrics (e.g., clean claim rate, denial rate, days in A/R).
  • Provide regular reporting to leadership on reimbursement trends and compliance status.
  • Recommend process improvements to enhance efficiency and collections.

Qualifications

• Required
• • Demonstrated experience with Rural Health Clinic billing and coding.
  • Strong understanding of Medicare and Medicaid RHC guidelines and encounter-based billing.
  • Knowledge of CPT, HCPCS, ICD-10 coding, and payer billing systems.
  • Experience with claim denials, appeals, and revenue cycle problem-solving.
  • Proficiency in electronic health records (EHR) and billing systems.
  • Certification in medical coding (e.g., CPC, CCS, or equivalent).
  • Certified Rural Health Clinic Professional (CRHCP)
  • Experience training staff in billing and coding practices.
  • Strong analytical and communication skills.

Competencies

• Detail-oriented with high accuracy in billing and coding.
• Strong problem-solving and critical-thinking skills.
• Ability to work independently while collaborating across teams.
• Commitment to compliance, integrity, and continuous improvement.

Equal Opportunity Employer
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