Hybrid Coder / Billing bei None

Job Announcement

Position Title:            Coder / Billing Clerk

Department:              Fiscal

Supervised By:         Revenue Cycle Manager

Location:                    Alpine

Status:                        Non-exempt/Hourly

Posted:                       August 4, 2025

Closing Date:            Until Filled

Compensation:         $25.68-$32.41/Hr DOE

Grant:                         N/A

Hours:                        Full time, Monday-Friday, 8:00AM-4:30PM

GENERAL STATEMENT OF RESPONSIBILITIES: 

Under the supervision of the Billing Manager/Coder, the Coder/Billing  Clerk will provide assistance with billing and clerical support services, as well as receptionist functions to the Billing department.

The employee reviews, analyzes, and codes diagnostic and procedural information that determines Medicare, Medicaid and third-party insurance payments.  The primary function of this position is to perform ICD-9/10-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.

SPECIFIC DUTIES AND RESPONSIBILITIES: 

1. Insurance verifications.
2. Insurance follow-up and inquiries.
3. Coordination of patient benefits.
4. Prepare and submit billing data and medical claims to insurance companies.
5. Follow-up on missed payments and resolve financial discrepancies.
6. Examine patient bills for accuracy and request any missing information to process rejected claims.
7. Investigate and appeal denied claims.
8. Run and review patient account statements monthly for medical, behavioral health, and dental.
9. Ensure proper balancing or all outstanding account balances with collections and denials.
10. Help patients develop patient payment plans.
11. Assist patients/providers with general insurance questions and benefits coverage.
12. Instruct patients how to contact their insurance carriers with questions and coverage.
13. Files and maintains an efficient filing system of patient information.
14. Collect co-pay payment and other patient payments
15. Complete and accurate coding of all outpatient claims as defined in the general statement of responsibilities
16. Request and verify procedure authorizations as needed. 
17. Advance 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.
18. Advance knowledge of medical codes involving selections of most accurate and description code using the ICD-9/10-CM, Volumes 1-3, CPT, HCPCS, and IHS coding conventions.
19. Skill in correlating generalized observations/symptoms (vital signs, lab results, medications, etc.) to a stated diagnosis to assign the correct ICD-9/10-CM code.
20. Advance knowledge of medical codes involving selection of most accurate and descriptive code using the CPT codes for billing of third party resources.
21. Extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes.
22. Knowledge of NextGen     to review encounters and notify providers of data that needs corrections. .
23. Must have good math skills and effective communication skills.  Must be knowledgeable of the fiscal requirements, policies, and procedures of federal, state, and tribal programs.  Requires the knowledge of the business use of computer hardware and software to ensure the effectiveness and quality of the processing and presentation of data.  Requires skill in the use of a wide variety of office equipment including: computer, typewriter, calculator, facsimile, copy machine, and other office equipment as required. Must be able to follow instructions and work independently.   
24. Ability to work a flexible schedule may be required based on need.
25. Other duties as assigned.

QUALIFICATIONS:

Education/Experience:  Certificate from a medical institute or an Associate of Arts or Science Degree and at least two (2) years of experience in Medical/Dental/Pharmacy field preferred.  Billing and collection experience preferred. Knowledge of medical terminology, anatomy and physiology, CPT,  and ICD-10 coding experience required.  Coding certification from a nationally recognized organization, such as AHIMA or AAPC.

Licenses/Certifications: A valid California driver’s license required with application submission and must be maintained throughout employment.  Applicant must be insurable under SIHC vehicle insurance policy at the time of hire and throughout employment.

Certifications and/or licenses appropriate to the positions required education and profession must also be valid and maintained.

Skills: Strong team building, interpersonal, and organizational skills. Ability to establish and maintain effective peer relationships with coworkers within the Department, clinic-wide, and the public. Must be able to express ideas clearly, concisely, address audiences effectively, and exercise balanced judgment in evaluating situations and making decisions. Willing to be part of a team and cooperate in accomplishing department goals and objectives. Ability to prioritize, meet deadlines, take initiative, be proactive, and function in a rapidly changing environment. Ability to work with people of all social and ethnic backgrounds and to resolve conflicts, negotiates situations, and facilitate consensus. 

Physical and Personal Requirements: Normal clinic/office environment. Sit or stand for long periods of time. Reach, bend, climb, stoop, lift up to 25 lbs. repetitive hand movement; use and view PC. Reliable transportation and car insurance as required by the state. Travel as needed.

Compliance: Each employee plays a key role in creating a compliance culture at SIHC. Employees are expected to learn and comply with all SIHC policies and procedures. One must have the ability to understand the implications and complexities of all compliance policies. Participation in all compliance training is mandatory, and generally have a heightened awareness of policies and regulations that are specific to one’s department and position. All SIHC employees are expected to report violations or suspected violations of compliance policies or regulations. 

Character:   Applicants must have a reputation for honesty and trustworthiness.  Must be responsible and able to exercise good judgment, accept administrative supervision, pay attention to detail, follow instructions, including the ability to interact effectively and communicate with people in a professional and courteous manner.  Must be highly confidential and work as a team with other staff.  Applicant should be sensitive to client’s needs.

Other: Applicants must successfully pass a pre-screening, including a tuberculin skin test or x-ray and a blood/urine drug screening test.  Health must be adequate to perform all duties of the position.  Applicant must complete SIHC Application and Authorization Form, both must be submitted to Human Resources prior to the close date indicated.

INDIAN PREFERENCE: 

INDIAN PREFERENCE: In the filling of any SIHC job vacancy, preference may be given to qualified Native American Indians, pursuant to  the Indian Preference Hiring Act, 25 USC 472,  unless other laws require the filling of a vacancy without regard to Indian preference (e.g.   Public Law (P.L.) 94-437, “Indian Health Care Improvement Act (IHCIA).   To receive Indian preference for any SIHC position, the applicant must be enrolled, or be eligible for enrollment, as an American Indian with their Tribe, or must be certified as an American Indian from the designated Tribal Representative. Applicants claiming Indian preference must attach verification of their claim to the SIHC application, including Certification of form BIA-4432, which is available from the SIHC Human Resources Department. If verification is not or cannot be verified, the applicant will not receive Indian preference for purposes of the interview.