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Department:  Business Services
Status:  Full Time
Shift:  1st

Reviews clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10-CM, ICD-10-PCS, and/or CPT-4 codes for professional billing, internal and external reporting, research, and regulatory compliance activities. Resolve error reports associated with the professional billing processes, identify and report error patterns and when necessary assist in the design and implementation of workflow changes to reduce billing errors. Must meet ongoing productivity and quality metrics as established within the department for each level.


Essential Functions

  • Extract data from one EMR system, interpret and input into Medical Billing system for multiple specialties
  • Oversee multiple specialty practices coding work-flow to ensure uniform processes and procedures
  • Utilize technical coding principles and reimbursement expertise to assign appropriate ICD-10-CM and CPT-4 procedure codes.
  • Assign codes for diagnoses, treatment, and procedures according to the appropriate classification system for Outpatient Procedures and limited Inpatient Procedures, including modifier assignment.
  • Review clinical notes to confirm compliance with service billing criteria
  • Ensure that claims are submitted efficiently to ensure they are filed within the timely-filing limits of each payer
  • Support the in-house billing team as requested to facilitate accurate claims
  • Review professional and outpatient medical record documentation and properly identify and assign ICD-10 CM, and/or CPT-4 codes for all reportable diagnoses and procedures:
  • Determine the correct principal diagnosis, co-morbidities, complications, secondary conditions, and surgical procedures.
  • Queries physicians per established policy and procedure when documentation is not clear or conflicting.
  • Possesses a good understanding of Medicare and Medicare specific billing requirements.
  • Meet and/or exceed the established quality standard of 95% accuracy rate or better while meeting and/or exceeding established production standards.
  • Keeps abreast of coding guidelines by self-study, assigned education, coding meeting attendance, or related in-services. Participates in internal and external quality review meetings

Education, Training, and Experience

Level I

  • Required: High school diploma or equivalent. Two years of professional coding experience or graduation from a CAHIM accredited HIT program and is CCS eligible or RHIT eligible.
  • Preferred: Successful completion of a certified coding program. Credentials to include one or a combination of the following: CCA, CCS, CCS-P, RHIT, and/or RHIA. CPC and/or CPC-H will be considered with relevant outpatient coding experience. 

Level II

  • Required: Two years of professional coding experience including, outpatient procedures and same-day surgery. Successful completion of a certified coding program. Credentials to include one or a combination of the following: CCA, CCS, CCS-P, RHIT, and/or RHIA. CPC and/or CPC-H may be considered with relevant outpatient coding experience.

Level III

  • Required:  Five years or greater of professional coding experience. Credentials to include one or a combination of the following: RHIA, RHIT, and/or CCS.
  • Preferred: Two years of progressive OP diagnostic coding experience.

Skills or Other Qualifications


  • Ability to code and maintain corporate/department-specific quality standards and meet productivity standards as documented by the department and organization.
  • Knowledge of medical terminology, anatomy and physiology, disease process, and minor surgical procedures.
  • Knowledge of accepted medical abbreviations and their meanings.
  • Knowledge in the use of specialized references such as the ICD-10-CM and CPT-4 books, medical dictionaries and texts, and medical journals.
  • Must have extensive knowledge of Coding Clinic, CPT Assistant, and all official coding guidelines.
  • Advanced knowledge of professional information systems, encoders, and other technology to facilitate a successful virtual work environment while maintaining maximum communication and adhering to HIPAA security standards.
  • Advanced knowledge of MS Excel, Word, and Outlook functions.
  • Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to all official coding guidelines.
  • Technical skills required to learn and navigate a variety of software systems, troubleshoot computer problems, install periodic updates to software programs, and work efficiently in a virtual environment.
  • Strong written and verbal communication skills.
  • Ability to think/work independently yet interact positively with a remote team.
  • Advanced problem-solving skills.
  •  Familiarity with current healthcare-based technology, coding, and Electronic Health Record (HER).
  • Attention to detail is crucial to this position.


  • Knowledgeable in Revenue Cycle department functions relating to Ambulatory Payment Classification (APC) grouping, denials, and edits.

License and Certifications

  • Required: See Above by Level
  • Preferred:  See Above by Level

Nearest Major Market: Orange County
Nearest Secondary Market: Los Angeles

Job Segment: Medical Coding, Compliance, EMR, Medicare, Law, Healthcare, Legal

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