Coding Specialist Biller 2 (WA)_Revenue Cycle Operations

About this position:Under the supervision and direction of the Director, Manager, or Supervisor, the Coding Specialist/Biller 2 ensures compliance in medical documentation, coding, and billing. This role performs the duties of the Biller 2, with time set aside for coding and documentation activities.

What you’ll be doing:You will ensure that coding and billing comply with applicable rules and regulations. You will work with staff to improve the front-end revenue cycle procedures carried out in our Health Centers, and you will support coding and revenue cycle activities.

Key Responsibilities

Perform prospective and retrospective coding reviews to ensure claims are accurate, and make needed corrections for payer reconsideration

Submit and manage provider coding queries for cases that need additional documentation or a provider response

Work assigned work queues to verify claim accuracy, take corrective action, and ensure timely filing

Write off balances when appropriate, up to the approval level authorized for a Coding Specialist/Biller

Review all rejections and denials, including coding and documentation issues, and take action to resolve claims

Identify trends in rejections and denials and report findings to the Coding Integrity Manager for follow-up

Ensure quality, compliance, and continuous improvement in coding, documentation, and billing

Accurately bill third-party payers to maximize reimbursement, following all department procedures and processes

Check proof of eligibility according to organizational and third-party protocols

Respond to inquiries from patients, health center staff, and insurance companies in line with affiliate customer service standards

Provide pre-verification services to health centers and patients as requested

Monitor help desk tickets, refer patient callback tickets to a Patient Account Representative when appropriate, and work other tickets to prompt resolution

Ensure bills are processed on time by managing work queues and correcting electronic bill submissions

Follow up on all incorrect, denied, and unpaid claims, and reconcile third-party accounting information

Support internal and external coding audits

Provide medical records for billing-related requests, including claim reimbursement, payer audit, and risk adjustment requests

Education:

Associate degree in finance, accounting, or a related field preferred

Certifications:

Certified Professional Coder (CPC) certification required

Experience:

Minimum of two years of experience in a medical billing operation required

Demonstrated experience with electronic practice management and health record systems (Epic a plus)

Experience with health center management highly desirable

Comprehensive, in-depth experience with the front-end revenue cycle

Skills

Thorough understanding of third-party payer contracts, Medicaid reimbursement, and compliance

Proficiency and advanced working knowledge of CPT-4 and ICD-10 coding requirements

Advanced knowledge of third-party billing and OIG billing compliance guidelines

Ability to maintain confidentiality of all PPGNHAIK business and activities, on and off the job

Salary Range:WA: $26.65 – $38.93 per hour

*Actual starting pay will be determined based on factors including, but not limited to, relevant experience, education, internal equity, geographic location, and the budgeted hiring range established for the position.

Location:2001 East Madison Street;Seattle, WA 98122

Position Type:Full-time – Non-exempt

Benefits Eligibility:This position is eligible for PPGNHAIK benefits. As part of our total compensation, we provide a comprehensive benefits plan including medical, dental and vision plans, retirement, paid time off, short and long-term disability, and life insurance. For more information about our benefits program, please email hre.contacts@ppgnhaik.org.

Other Information:All our employees must present proof of receiving a current flu shot prior to their first day of employment.

What we expect from you:

That you adhere to our code of conduct, policies, procedures, and protocols.

That you always demonstrate a high degree of professionalism.

That you always support and model our customer service standards.

That you value continuous learning and seek ongoing training and development.