About this role
We are seeking a highly skilled and experienced Senior Certified Coder with expertise in Federally Qualified Health Center (FQHC) coding and billing practices. The ideal candidate will hold a certification through either the AAPC (American Academy of Professional Coders) or RHIT (Registered Health Information Technician) and possess in-depth knowledge of FQHC coding standards, payer requirements, and federal healthcare regulations.
As a Senior Certified Coder, you will be responsible for accurately coding a variety of services provided within the FQHC environment, ensuring compliance with all applicable regulations, and collaborating with multidisciplinary teams to support optimal revenue cycle management.
Key Responsibilities:
- Perform detailed coding of outpatient visits, including but not limited to primary care, behavioral health, dental, and preventive services, in accordance with FQHC guidelines.
- Ensure proper coding and billing for Medicare, Medicaid, and commercial insurance payers, adhering to federal, state, and payer-specific regulations.
- Review clinical documentation to verify accuracy and ensure appropriate coding is used.
- Serve as a coding resource for team members, providing mentorship and training as needed.
- Review and resolve coding discrepancies, audits, and billing issues promptly.
- Collaborate with clinical and administrative staff to ensure accurate and timely claims submission.
- Participate in internal and external audits, assisting in chart reviews and responses to coding-related queries.
- Maintain up-to-date knowledge of coding updates, payer policies, and FQHC-specific regulations.
- Assist in the development and implementation of coding policies, procedures, and educational resources.
- Support the improvement of revenue cycle processes and workflows to maximize reimbursement and minimize errors.
- Required Certifications: AAPC (CPC, CPC-H, or CPC-P) or RHIT (Registered Health Information Technician) certification.
- Experience: Minimum of 5 years of professional coding experience, with at least 3 years in an FQHC setting.
- Extensive experience with ICD-10-CM, CPT, HCPCS Level II, and Medicare/Medicaid coding guidelines.
- Strong understanding of FQHC-specific reimbursement models, including PPS (Prospective Payment System), RHC (Rural Health Clinics), and billing procedures.
- Proficient in using electronic health record (EHR) systems, coding software, and practice management systems.
- Knowledge of compliance regulations related to FQHCs and the healthcare industry.
- Strong attention to detail, analytical skills, and the ability to manage complex coding issues.
Qualifications
Qualifications:
- Required Certifications: AAPC (CPC, CPC-H, or CPC-P) or RHIT (Registered Health Information Technician) certification.
- Experience: Minimum of 5 years of professional coding experience, with at least 3 years in an FQHC setting.
- Extensive experience with ICD-10-CM, CPT, HCPCS Level II, and Medicare/Medicaid coding guidelines.
- Strong understanding of FQHC-specific reimbursement models, including PPS (Prospective Payment System), RHC (Rural Health Clinics), and billing procedures.
- Proficient in using electronic health record (EHR) systems, coding software, and practice management systems.
- Knowledge of compliance regulations related to FQHCs and the healthcare industry.
- Strong attention to detail, analytical skills, and the ability to manage complex coding issues.
Preferred Skills:
- Experience with EHR systems such as EPIC, Athena Health, or Centricity.
- Strong communication skills with the ability to work collaboratively across departments.
- Ability to mentor and train junior coders and provide guidance on coding best practices.
Additional Requirements:
- Ability to maintain confidentiality and adhere to HIPAA regulations.
- Strong organizational skills and the ability to prioritize tasks in a fast-paced environment.
- Demonstrated commitment to continuous learning and professional development in coding and healthcare regulations.