Billing And Coding Jobs in Modesto, CA (NOW HIRING)

Work schedule: On-site / Full-time Days; 8 a.m. until 5 p.m. Monday through Friday

PRIMARY PURPOSE

Responsible for leading audits that analyze clinical or operational work processes, policies and procedures to ensure compliance with all laws, regulations, internal policies as well as State/Federal program guidelines. Serves as a resource both internally and externally regarding audit-related issues.

This position is essential for evaluating, improving, and enhancing our organization's internal controls, risk management, and governance processes.

MINIMUM SPECIFICATIONS

Education

• Bachelor's degree in accounting, finance, healthcare administration, or related discipline required.

• Master's degree preferred.

Experience

• Five (5) years of experience in internal auditing, medical billing/coding, or clinical experience in a healthcare setting.

• Data analytics experience including experience with tools such as SQL, Python, R, SAS, Tableau, Power BI, or ACL.

• Experience with healthcare compliance standards, billing & coding practices, risk management, and regulatory frameworks.

Equivalent Education and/or Experience

• Master's degree in lieu of two (2) years of relevant experience.

Certification/Registration/Licensure

• Certified Internal Auditor (CIA), Certified Public Accountant (CPA), Registered Health Information Administrator (RHIA), Registered Nurse, or similar healthcare-related designation required upon hire or commitment to obtain within two (2) years from date of entry into position.

Required Tests for Placement

• None.

Skills or Special Abilities

• Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines. Ability to communicate complex information in understandable terms.

• Strong interpersonal and conflict resolution skills with the ability to establish and maintain effective working relationships across and beyond the organization.

• Excellent analytical and problem-solving skills.

• Strong time management and organizational skills with the ability to manage multiple demands and respond to rapidly changing priorities.

• Ability to write clearly and succinctly with a high level of attention to detail. Knowledge of regulatory requirements and standards applicable to the healthcare environment. Ability to interpret government regulations that apply to Parkland and employ effective problem-solving skills to make appropriate recommendations for process improvement.

• Ability to review and interpret electronic medical record documentation and be able to review charges and claims information against chart documentation. Expert Microsoft Office and computer skills with the ability to input, extract and manipulate large data sets and analyze information. Ability to learn new software programs.

Responsibilities

Audit Program

• Plan, lead, and execute complex audit engagements across various healthcare functions including clinical operations, revenue cycle, billing, coding, and regulatory compliance to detect errors or irregularities and ensure compliance with relevant laws, regulations, and guidelines of Federal and State programs.

• Responsible for each phase of the audit process.

• Conduct risk assessments and develop audit programs that incorporate advanced data analytics to assess internal controls and operational effectiveness.

• Utilize tools such as SQL, Python, R, Power BI, or Tableau to extract, manipulate, and visualize large datasets to identify trends, red flags, and audit targets.

• Collaborate with cross-functional teams to collect and validate data from disparate systems (EHRs, ERP, billing platforms).

• Prepare clear, well-documented audit workpapers, findings, and recommendations aligned with IIA standards and healthcare industry best practices.

• Present findings to senior leadership and stakeholders, providing data-backed insights and actionable recommendations.

• Monitor and follow up on the implementation of audit recommendations and corrective actions performing follow up reviews as necessary.

• Maintains current knowledge on healthcare regulations (CMS, HHS, OIG, etc.) and emerging risks in healthcare technology and data privacy.

Regulatory

• Ensures work is carried out in compliance with regulatory and/or accreditation standards as well as contractual requirements.

Professional Accountability

• Promotes and supports a culturally welcoming and inclusive work environment.

• Acts with the highest integrity and ethical standards while adhering to Parkland's Mission, Vision, and Values.

• Adheres to organizational and department policies, procedures, and guidelines.

• Completes assigned training, self-appraisal, and annual health requirements timely.

• Attends required meetings and town halls.

• Recognizes and communicates ethical and legal concerns through the established channels of communication.

• Demonstrates accountability and responsibility by independently completing work, including projects and assignments on time, and providing timely responses to requests for information.

• Maintains confidentiality at all times.

• Performs other work as requested that is reasonably related to the employee's position, qualifications, and competencies.

Job Accountabilities

• Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland.

• Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.

• Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.