Patient Accounts Biller/Certified Coder

San Diego, CA
Finance
Full Time
Planned Parenthood of the Pacific Southwest has been voted one of the best places to work. We are one of the largest providers of reproductive healthcare in Southern California, operating 17 health centers throughout our three county region. Check out our new video, "We are Planned Parenthood of the Pacific Southwest” for more information about our organization: https://youtu.be/2ATarFSN3TQ.

Care. No Matter What.

Planned Parenthood of the Pacific Southwest is seeking a Patient Accounts Biller/Certified Coder.

The Patient Accounts Biller/Certified Coder ensures coding information is accurate to support the level of care provided and supported by clinical documentation in the electronic medical record to obtain accurate reimbursement for healthcare services.  The Patient Accounts Biller/ Certified Coder will also provide internal audit services, compliance consulting, and serve as the subject matter expert (SME) related to coding education and training.

Qualifications

    • Active/Current CPC Certificate with American Academy of Professional Coders or CCS credentials.
    • Associates Degree, Bachelor’s degree preferred. 
    • 3+ years’ experience in billing and coding
    • 2+ years’ experience with insurance billing and payer reimbursement protocols in an out-patient setting.
    • MediCal and Family PACT coding experience preferred

Job Responsibilities

    • Determine and supply correct CPT, HCPCS, ICD9/10, and appropriate modifiers on pre-determined selected charges based on medical documentation. 
    • Compile coding and clinical documentation error trends and assist with process improvement and training. 
    • Collaborate and communicate with leadership to aid in educating providers regarding documentation updates, coding updates and legal updates.  
    • Responsible for compiling and updating leadership on payer coding updates, NCCI updates for Medicaid, Medicare and all other third party payors.
    • Audit medical record documentation to identify under coded and up coded services; prepare report and meet with leadership to provide education and training on accurate coding practices and compliance issues.
    • Research, analyse, and respond to inquiries regarding compliance, inappropriate coding, denials, and billable services.
    • Interact with providers and leadership regarding billing and documentation of policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific documentation.
    • Contribute to the development of educational and training documents for providers. 
    • Provide technical support to providers and leadership regarding coding compliance documentation, regulatory provisions and third party payer rules.  
    • Prepare and submit clean claims to third party payers, either electronically or on paper; work claim rejections.
    • Analyze and process third party payments/adjustments.
    • Determine the appropriateness of appealing denied claims and take necessary actions to resubmit those claims on a timely basis.
    • Work aging and rebill reports; perform effective follow-up on unpaid claims.
    • Researches issues involving patient demographics and insurance eligibility.
    • Answers questions from patients, internal customers and insurance companies.
    • Prepares, reviews, and sends patient statements.
    • Identifies and resolves patient billing complaints.
    • Perform various collection efforts including contacting patients by phone.
    • Participates in educational activities and attends monthly meetings.
    • In support of PPPSW’s Just Culture Philosophy, identify and report errors, near misses, and employee, patient and customer safety concerns in a timely manner.   
    • To support risk and quality management by proactively communicating identified risks to supervisor in order to minimize risk when possible.
    • Comply with PPPSWs Code of Conduct and maintain the highest level of professional and ethical standards and to act in compliance with both the letter and spirit of all applicable laws and regulations.
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We are the power of Planned Parenthood.

We are Planned Parenthood of the Pacific Southwest, one of the largest and most prominent affiliates of the most iconic health care organization in the world. We are recognized for the wide array of services we provide and the outstanding education we deliver.

We are a prominent and powerful team of health experts who work relentlessly to help our communities sustain their health and well-being. We adhere to the highest standards and protocols as we collaborate and care for people, without judgment.

100 years of advocating for our mission has secured our advancement, our future and our passion for practicing health care.

We are a team you can have fun with and a powerful movement you can be part of. Together we’ll take pride in shaping the future of sexual health and reproductive rights.

For those who feel that purpose is critical to their work, this is a gift.

In This Together.

Planned Parenthood of the Pacific Southwest is an Equal Opportunity Employer.
Please visit our careers page for more information: www.pppswcareers.org