Accredited CPC Medical Coding Specialist

Accredited CPC Medical Coding Specialist

Winchester, CA $46,089 - $62,079 a year

Full Time

Position Overview

This role is responsible for accurately determining codes for physicians' diagnoses and procedures, ensuring compliance with the latest medical reimbursement policies and CMS guidelines. The specialist reviews medical records to identify all appropriate coding, generates invoices for insurance and patient billing, and manages insurance claims and collections. Collaboration with clinical teams and patients is essential to ensure precise and complete charge preparation for patient visits.

Key Responsibilities

• Maintain a safe and clean work environment, adhering to unit safety and infection control standards.
• Coding Duties:
  • Utilize Electronic Health Records (EHR) to support claim coding.
  • Assign ICD-10-CM, CPT-4, and HCPCS codes for surgeries based on current guidelines.
  • Review physician notes for accuracy and completeness.
  • Communicate with physicians to clarify or correct documentation as needed.
  • Ensure all medical records are complete, including proper timing, dating, and signatures.
  • Apply modifiers according to payer guidelines.
  • Understand documentation and compliance requirements for coding.
  • Maintain strict confidentiality and comply with HIPAA regulations protecting Protected Health Information (PHI).
• Insurance and Patient Billing:
  • Process and submit electronic claims efficiently.
  • Address and correct electronic claim rejections promptly.
  • Resolve all NCCI edits within two business days to ensure timely claim submission.
  • Print paper claims when necessary.
  • Provide cash quotes for self-pay surgeries and collect payments for non-covered procedures and injections.
• Auditing:
  • Follow up on claim acceptance or rejection.
  • Investigate reasons for claim denials and take corrective action.
• Perform additional duties as assigned.

Qualifications

• At least one year of healthcare experience.
• Strong knowledge of medical terminology, human anatomy, and coding methodologies.
• Moderate understanding of Level 1 and 2 modifiers.
• Ability to review documents for accuracy and completeness.
• Detail-oriented with strong problem-solving skills.
• Knowledgeable in NCCI, CCI edits, and LCDs, with the ability to apply regulations accurately.
• Effective communication skills and ability to collaborate with coworkers.
• High ethical standards and professional integrity.
• Strong analytical and persuasive communication skills at all organizational levels.

Education

• High school diploma or GED required.
• Certificate or diploma from an accredited medical coding program.

Certification

• Current CPC, CPC-A, CCS, or RHIT certification required.

Employment is contingent upon passing a physical evaluation, drug screening, and background checks prior to starting work.

This position is located in a regional healthcare setting within the Pacific Northwest, serving diverse coastal communities with a commitment to compassionate and quality patient care.