Tri-City Medical Center

  • Billing/Coding Specialist

    Posted Date 9 months ago(5/3/2018 12:17 PM)
    FTE Status
    Full-Time 1.0
    Cost Center/Dept
    7095 - OSNC
    Work Schedule
    Clinic Hours as required. Located in Vista
  • Overview

    Position Summary:

    Is responsible for determining accurate codes for physician’s diagnoses and procedures. Keeps up-to-date with the latest medical compliance and reimbursement policies.  Reviews medical record information to identify all appropriate coding, ensuring that it is compliant with the latest reimbursement policies and CMS guidelines. Generates invoices to be sent to insurances and to patients.  Sorts and files paperwork, handles insurance claims and performs collections duties.


    This position will work with the practice patients and clinical teams to accurately and completely code and prepare charges to be sent out for the patient’s visit.



    • Utilizes EHR for any documentation needed to support coding of a claim
    • Efficiently assigns ICD-10-CM, CPT-4 and HCPCS codes for surgeries from documentation based on the most current guidelines
    • Reviews note prepared by physician and ensures that no mistakes are made in those notes
    • Contacts physician if information is missing and gets the information filled in an/or corrected
    • Makes sure all medical record files are complete (including timed, dated, and signed)
    • Assigns modifiers based on payor guidelines
    • Understands documentation and compliance requirements for assigning of codes
    • Maintains strictest confidentiality and follows HIPAA guidelines for protecting Protected Health Information (PHI)

    Insurance/Patient Billing

    • Processes and submits electronic claims
    • Corrects electronic rejection edits
    • Ensures all NCCI edits are resolved within 2 business days to ensure claims are submitted within 5 days from service date
    • Prints paper claims as needed
    • Provides cash quotes for self-pay surgeries
    • Quotes and collects cash for non-covered procedures and injections


    • Follows up to see if claim is accepted or rejected
    • Investigates rejected claim to see why denial was issued
    • Performs other duties all other duties as assigned

    Safety and Infection Control Responsibilities

    • Responsible to maintain a safe and clean environment, including department/unit based safety and infection control requirements.


    • Demonstrates behaviors that are consistent with the Medical Center’s Mission and Values
    • Performs job responsibilities in an ethical, compliant manner consistent with the Medical Center’s values, policies, procedures and code of conduct.
    • Works well with team members toward a common purpose. Reinforces the efforts and goals of the work group. Supports the team’s decisions, regardless of individual viewpoint.
    • Demonstrates flexibility in schedules and assignments in order to meet the needs of the Work Unit/Department.
    • Utilizes, maintains, and allocates equipment and supplies in a cost effective and efficient manner. Improves productivity through proper time management
    • Seeks feedback from customers and team members in order to identify and improve processes and outcomes.



    • High School Diploma or equivalent, required
    • Certificate or Diploma from an Accredited Program in Medical Coding
    • Current CPC, CPC-A, CCS, or RHIT certification required
    • Minimum of 1 year of experience in health care
    • Demonstrates a good working knowledge of medical terminology, human anatomy and coding methodology
    • Possesses moderate knowledge of Level 1 & 2 modifiers
    • Ability to examine documents for accuracy and completeness
    • Detail oriented with ability to identify and resolve problems
    • Must possess moderate knowledge of NCCI, CCI edits and LCDs and be able to accurately apply regulation knowledge to coding situations
    • Ability to communicate clearly and work effectively with co-workers
    • Strong ethics and a high level of personal and professional integrity
    • Strong analytical skills
    • An effective communicator at all levels in the organization, with strong oral, written and persuasive skills


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