Coder

To be considered for the position, applications must be fully completed and submitted by the posted end date.

Summary:

Applicant must possess a high school diploma or equivalent and graduation from an accredited coding certification program. Certification as a Certified Professional Coder (CPC) or Certified Professional Biller (CPB) through the American Academy of Professional Coders (AAPC) is required. A minimum of one year of experience with coding in an ambulatory care setting, including evaluation and management (E/M) coding of physician services and laboratory coding. CPR (BLS Provider) certification through the American Heart Association (AHA) or the American Red Cross. Certification may be obtained with 90 days of employment.  Knowledge of ability to interpret medical record documentation for accuracy and completeness. Knowledge of Medical Terminology preferred.  Knowledge of the standards of Coding as set forth by the American Health Information Management Association (AHIMA) or American Association of professional coders (AAPC).The Coder is responsible for coding and billing physician-based services, including medical, behavioral health, laboratory, radiology, optometry, nutrition, and telehealth services to ensure accurate reimbursement and compliance with federal, state, and regulatory guidelines. The position reviews medical record documentation, assigns appropriate CPT, HCPCS, and ICD-10-CM codes, and supports accurate claims processing using current classification systems. Must be able to work with the Indian community and be sensitive to the Indian culture and its needs.

Major Duties and Responsibilities:

• Ability to accurately assign and sequence principal and secondary diagnosis and procedure codes based on documentation.  Follow correct coding initiative (CCI) guidelines for optimal reimbursement.
• Identifies and assigns appropriate codes for the purpose of reimbursement, research, and compliance in accordance with ICD-10, CPT, and HCPCS coding guidelines
• Accurately extracts clinical information from NextGen encounter records according to established requirements.
• Accurately assign evaluation & management, procedures CPT and diagnosis ICD-10-CM Codes based on provider documentation by utilizing NextGen coding tools E&M Calculator, and NCCI edits
• Ensures documentation support coding and billing; if clarification needed coder/biller to submit a provider query via task list.
• Interpret coding rules and general policies in addition to determining appropriate conclusions
• Complies with all federal, local and other legal requirements as they relate to medical coding/billing practices
• Observes confidentiality and safeguards all patient related information
• Must be able to explain billing, codes, terminology and coding guidelines to physicians and RSBCIHI personnel
• Performs claim review, verifies accuracy and completeness of all required information to perform submission to Medicare, Medicaid, commercial and private insurance payers
• Meet coding/billing productivity of 100 encounters daily and maintain minimum 95% quality assurance.
• Accurately assign appropriate modifiers based on payor type.
• Accurately post encounter information including but not limited to, billing area and location to individual patient accounts on computer NextGen system.
• Attends continuing education classes to maintain coding proficiency in ICD-10-CM, CPT/HCPCS, and other areas as deemed necessary by management.
• Uses time efficiently to ensure that daily tasks are complete and that all jobs completed are in accordance with the established department policy, procedures and standards.
• During periods of personnel shortage and heavy workload, is able to aid others in the completion of the work without compromising their own work.
• Presents a professional, business-like image when dealing with others, whether face-to-face or via telephone.
• Demonstrates a willingness and proficiency to assist in other areas of the department when asked and/or needed as evidenced by:

1. Exhibiting a strong understanding of department priorities and incorporates this to maximize department efficiency.
2. Having a broad knowledge of department operations and an ability to work proficiently in multiple areas.
3. Accepting requests from supervision with minimal disruption and maximum efficiency.

• Demonstrates ability to get along well with fellow employees and supervisors, promoting an environment of efficiency and teamwork.
• Communicates in a positive and professional manner with visitors, physicians, and staff
• Effectively demonstrates the mission and values of the organization on a daily basis as evidenced by:

1. Exhibiting behaviors which reflect a positive regard for the organization, job, and others by representing Riverside-San Bernardino County Indian Health, Inc. in a favorable light; refraining from public criticism of RSBCIHI or its policies and personnel.
2. Showing concern and respect for others by interacting with people in a compassionate, sensitive, and responsive manner, listening attentively to spiritual and psychosocial concerns.
3. Respecting patient’s rights, including confidentiality
4. Other duties as assigned relevant to the position, with relevant training and competency assessment documented within the level of their licensing or certification. 

Education:                              

High school diploma or equivalent 

Certified as a Certified Professional Coder (CPC) or Certified Professional Biller (CPB) through the American Academy of Professional Coders (AAPC) is required. 

Experience:

Minimum of one to three years of coding experience, including evaluation and management (E/M) coding of physician services and laboratory coding.

Certification:

Must have current CPR (BLS Provider) certification through the American Heart Association (AHA) or the American Red Cross. Certification may be obtained within 90 days of employment.

License:

Valid California Driver’s License with a safe driving record, DMV record required. Must be insurable by the program’s insurance carrier.

Knowledge of:  The ability to interpret medical record documentation for accuracy and completeness. Knowledge of Medical Terminology preferred.  Knowledge of the standards of Coding as set forth by the American Health Information Management Association (AHIMA) or American Association of professional coders (AAPC). Excellent command of diagnostic and procedural classification systems with thorough understanding of the effect of data quality on prospective payment, utilization, and reimbursement. Proficient knowledge of anatomy and physiology. Proficient knowledge of ICD, CPT/HCPCS coding systems. Proficient in encoder technology and knowledge of third-party payer requirements. 

Skill:            Possess strong written and verbal communications skills to communicate effectively with individuals at all levels of the organization. Able to use computer, printer, and software programs necessary to the position (e.g., Word, Excel, Outlook, and PowerPoint). Operate/troubleshoot basic office equipment required for the position. Able to think critically; manage multiple assignments effectively; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; work independently with minimal supervision.

Ability to:        

Must be able to work with the Indian Community, and be Sensitive to the Indian culture and its needs.  Think intelligently, capable of making logical decisions based on information received.  Comprehend verbal and written instructions.

Physical Demands:

Must be able to sit or stand for long extended periods of time. Must be able to key data and view a computer monitor.  Ability of hands movement with coordination of eye. Occasional lifting of coding books or records (up to 25 lbs).

Appointment Type: 

Full-Time, Non-Exempt

Compensation:

$26.50–$27.50 per hour ($55,120–$57,200 annually, depending on experience and internal equity) 

Clinic Location: San Manuel Clinic as Assigned

San Manuel Indian Health Clinic (11980 Mt. Vernon Ave. Grand Terrance Ca, 92313), and  Soboba Indian Health Clinic (23119 Soboba Rd San Jacinto, Ca 92583)

Salary : $27 - $28