Certified Coding Specialist

Clinical Medical Billing and Coding Coordinator
 Serves as initial point of contact for providers and members in the medical management process by telephone or correspondence. Supports the Billing and Coding cycles for providers, coordination of benefits for patients, and processes claims accordingly. Assists in ensuring members are effectively and efficiently managed through the medical/disease management process as needs require. Within extension of authority, assigns length of stay on acute inpatient admissions, as well as approves specific home health, DME. Process authorization requests and facilitates referrals. Assists with system letters, requests for information and data entry. Provides administrative/clerical support to medical and disease management.

Specific Responsibilities Include:
  • Process faxed/phoned in authorizations; calls left on voicemail.
  • Data entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation.
  • Respond to inquiry calls on as needed.
  • Advance cases to senior staff.
  • Research member eligibility/benefits and provider networks.
  • Works directly with Providers and Staff to verify services rendered and documented
  • Provide feedback to assist in understanding of coding documentation issues and opportunities for improvement of process
  • Builds external relationships, serves as a point of contact for informational purposes or issues
  • Works to deliver on day-to-day objectives with direct impact on achievement of results for the job area.
  • Work consists of tasks that are typically routine, with some deviation from standard practice.
  • Works under moderate supervision for routine tasks. May seek advice of more senior personnel in the same area. Keep supervisor informed of issues, activities, progress, and problems.
  • Checks and makes minor adjustments to work methods to solve problems that are routine and typically exist in current work processes and systems. May be required to highlight areas of concerns/problems and put forth solutions to supervisor in own job area.
  • Problems and issues faced are generally routine but may require some interpretation of procedures or policies to resolve problems.
  • Communicates with contacts typically within the job area on matters that involve obtaining or providing information requiring some explanation or interpretation to reach agreement.
  • May provide guidance and assistance to new or entry-level employees.
  • Perform record audits.
  • Maintain accurate logs, card files, statistics, and information release forms for providing medical record information.
  • Responsible for providing guidance, coaching, and training to other employees within job area
  • Other duties as assigned/Special Projects, work with FT Coder to capture HEDIS measures in encounters to ensure compliance.
  • Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork Activity level: Sedentary, frequency most of workday.
Required Skills
1. Medical Coding/Billing Certification
2. Min 5 Years Exp.
3. Working knowledge of CPT, ICD-10 and HCPCS coding

Education Requirement: Highschool Diploma/GED
Required Certifications: Medical Billing and Coding
Salary Range
$43,000.00 - 66,000.00
per Year
Salary range estimated by
Palmdale, CA 93552, US
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