Job Details

Why work for us? Flexible Schedules, Full-Time with Benefits
Clinic Hours: Monday – Friday, 8:00 AM to 5:00 PM

Job Purpose: The Coder performs highly technical and specialized functions for Sonoma County Indian Health Project, Inc. (SCIHP). The Coder reviews, analyzes, and codes diagnostic and procedural information that determines Medicare, Medicaid and commercial insurance payments.  The primary function of this position is to perform ICD-10-CM, CPT and HCPCS coding for reimbursement.  The coding function is a primary source for data and information used in health care today, and promotes provider/patient continuity, accurate database information, and the ability to optimize reimbursement. The coding function also ensures compliance with established coding guidelines, third party reimbursement policies, regulations, and accreditation guidelines.  The Coder specifically ensures SCIHP`s compliance with all regulations, as well as providing up to date education and training to SCIHP providers.

Qualifications:

• High school diploma or general education degree (GED).
• CPC (Certified Professional Coder) Certification, required.
• Minimum 1 to 3 years of related experience and/or training or equivalent combination of both is preferred.
• Collaborates with billing department to ensure all bills are satisfied in a timely manner.
• Review claims data to ensure that assigned codes meet required legal and insurance rules and that required signatures and authorizations are in place prior to submission.
• Conducts medical records research and corresponds with insurance companies and healthcare professionals to resolve if a claim is denied due to incorrect coding.
• Advanced knowledge of medical terminology, abbreviations, techniques and surgical procedures; anatomy and physiology; major disease processes; pharmacology; and the metric system to identify specific clinical findings, to support existing diagnoses, or substantiate listing additional diagnoses in the medical record.
• Advanced knowledge of medical codes involving the selection of the most accurate and descriptive code, using ICD-10-CM, CPT and HCPCS codes for billing of third-party resources and IHS coding conventions.
• Skill in correlating generalized observations/symptoms (vital signs, lab results, medications, etc.) to a stated diagnosis to assign the correct ICD code.
• Knowledge of NextGen EHR and PM (preferred but not required).
• Ability to query providers for clarifying information for complete and accurate documentation.
• Ability to perform other duties as assigned, including billing duties.
• Must pass a pre-employment drug screen, physical and background investigation.
• Must have proof of completed COVID vaccination.

Special Qualifications: Must be sensitive to the needs of the Native American Community, which includes culture, traditions, and background.