Revenue Cycle Billing & Coding

RCM Biller/Coder

The intent of this job description is to provide a summary of the major duties and responsibilities performed in this job. Incumbents may be requested to perform job-related tasks other than those specifically presented in this description.

The RCM Biller/Coder is responsible for the accurate coding and billing of professional services to ensure timely, compliant, and clean claim submission across all affiliate sites. This role supports both Athena and Epic workflows and applies current CPT, ICD-10-CM, and HCPCS coding guidelines in alignment with Rancho Family MSO Revenue Cycle Management (RCM) policies and payer requirements. The Biller/Coder works collaboratively with RCM leadership and team members to resolve coding issues, address denials, and support optimal revenue cycle performance.

Essential Job Duties: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Accurately assign CPT, ICD-10-CM, and HCPCS codes based on provider documentation and established coding guidelines.
• Code and bill claims in a timely manner to support clean claim submission and optimal first-pass resolution rates.
• Manage assigned coding and billing work queues in Athena and Epic in accordance with established workflows and productivity standards.
• Identify documentation gaps or inconsistencies and route for clarification or correction as appropriate.
• Review and assist in resolving coding-related denials, medical necessity issues, and payer rejections.
• Follow up on unpaid or denied claims requiring coding review to support prompt resolution and reduce rework.
• Respond to internal billing and coding inquiries within defined escalation pathways.
• Maintain compliance with payer policies, regulatory requirements, and internal RCM standards.
• Stay current on coding updates, payer policy changes, and regulatory guidance relevant to assigned specialties.
• Participate in team meetings, training sessions, and quality improvement initiatives as required.
• Adhere to standardized workflows and documentation practices within Athena and Epic systems.
• Perform other duties as assigned to support departmental and organizational needs.

Required education and experience: The requirements listed below are representative of the knowledge, skills, and/or ability required.

Minimum Education required:

• High school diploma or equivalent required.
• Associate or bachelor's degree in Health Information Management or a related field preferred.
• Current coding certification required (CPC, CCS, or equivalent).

Minimum Experience Required:

• Minimum of 2–4 years of medical billing and/or coding experience.
• Experience in a multi-specialty and/or multi-site environment preferred.
• Prior experience working in Athena and/or Epic required.
• Experience supporting denial resolution and claim follow-up preferred.

Minimum Knowledge and Skills Required:

• Working knowledge of CPT, ICD-10-CM, and HCPCS coding standards.
• Understanding of payer requirements, claim submission processes, and denial workflows.
• Strong attention to detail and commitment to accuracy.
• Ability to manage assigned workloads and meet productivity and quality expectations.
• Effective written and verbal communication skills.
• Ability to work independently while collaborating within a team environment.
• Proficiency navigating Athena and Epic billing and coding workflows.
• Strong organizational and time-management skills.

Hybrid work schedule, must be able to commute to Temecula.