Claims Edit Coder Jobs in Mountain View, CA (NOW HIRING)

El Camino Health is committed to hiring, retaining and growing the best and brightest professionals who will carry our mission and vision forward. We are proud of our reputation in the community: One built on compassion, innovation, collaboration and delivering high-quality care. Come join the team that makes this happen.
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FTE
1
Scheduled Bi-Weekly Hours
80
Work Shift
Day: 8 hours
Job Description
The HIM PB Coding Manager is responsible for day-to-day management, oversight, and quality assurance of professional billing coding operations, providing leadership and management of the HIM Professional auditors and coders reviewing physician base charging/billing, claim edits, payer appeals, with accurate, compliant, and timely coding of professional services according to Official Coding and regulatory guidelines and internal standards. Provide physician education with extensive knowledge in ICD-10-CM diagnosis, CPT procedural assignment, and HCPCS level II coding systems for El Camino Health Medical Network. The PB coding manager educates providers in the clinic base and hospital setting to ensure documentation meets the reporting requirements to support medical necessity in adherence with payer requirements with billed charges. The PB coding manager leads a team of professional coders and collaborates closely with the Revenue Cycle professional billing teams ensuring providers charging/billing are compliant in adherence with Official Coding Guidelines, American Medical Association CPT procedural assignments and Healthcare Common Procedure Coding System (HCPCS) requirements. The PB coding manager maintains providers monthly audits and reports to the ECHMN compliance committee.
HIM Professional Billing Coding Manager's core duties:

• Primary lead educator with sessions onsite and in electronic format for new and existing providers/clinicians.
• Oversee the professional coding of evaluation & management (E/M), surgical, and diagnostic services.
• Ensure accurate CPT, HCPCS, and ICD-10-CM code assignment by physicians for all PB claims.
• Monitor coding compliance with CMS, OIG, payer-specific guidelines, and organizational policy.
• Monitors un-billed, claim edit, and denial claim reviews ensuring revenue metrics do not exceed claims submissions.
• Coordinates monthly external professional audits with third-party vendors in collaboration with Compliance and the HIM Coding manager. Extracts and uploads audited data from third-party vendors and coordinate other team members' assignments in maintaining all monthly audits are completed in a timely manner.
• Work closely with Revenue Integrity and Billing to streamline processes and resolve coding/billing issues.
• Maintain communication with leadership regarding trends, backlogs, and regulatory changes.
• Leads educational sessions with the coding team by conducting research on various regulatory sites and coding guidelines in creating educational content for both clinicians and coding team members in reducing claim and payer denials providers continuous education strategies.
• Performs reviews of payer denials and analyze/track coding denials and documentation deficiency trends in providing monthly provider/clinician education.
• Supervise, coach, and evaluate a team of professional coders and perform educational training of new and existing coding staff.
• Conducts internal and external auditing of coding staff team members by providing educational monthly reporting to reduce claim denials for ECHMN medical documentation by updating ECH Professional Coding Guidelines and creation of monthly educational newsletters to the El Camino Health Medical Network
• Coordinates with the facility HIM coding manager with professional surgical and obstetrical coding of claims
• Ensure department goals and KPIs (e.g., coding reviews/release of provider's charges turnaround times, and quality scores) are met.

Qualifications

• Minimum (5) years of professional coding/auditing experience in a multispecialty healthcare setting for professional physicians claims to include evaluation and management services, ICD-10-CM diagnosis, HCPCS, and CPT coding for both inpatient and outpatient services, required
• At least 5 years of experience in a supervisory or management role within the HIM Coding department preferred.
• In-depth knowledge of physician coding across specialties, E/M leveling, surgical coding, and modifier usage.
• Electronic Health Records (EHR): EPIC or equivalent enterprise EHR systems experience Required.
• Experience with EPIC's PB module (Professional Billing) strongly preferred.
• Coding and Billing Tools: Epic AI tools
• Reporting & Analytics: Proficient in MS Excel to include pivot tables, and VLOOKUPs), Word, and PowerPoint
• Familiarity with reporting tools such as EPIC Clarity, Crystal Reports, Tableau, or Power BI a plus.
• Exposure to compliance software tools for audit management, and knowledge of OIG work plans, CMS NCCI edits, and payer policies.
• Revenue cycle knowledge of claims reimbursement associated with CMS LCD and NCD policies
• Demonstrate excellent oral and written communication and presentation skills
• Strong leadership, communication, interdepartmental collaborative relationships and conflict resolution skills.
• Strong organizational skills and ability to prioritize multiple activities and objectives in given timelines.
• Creative in problem solving skills and able to work under pressure and continuous change
• High attention to detail with excellent problem-solving abilities with ability to interpret complex regulatory and payer guidelines.

License/Certification/Registration Requirements

• Certified Professional Coder (CPC) and Certified Professional Medical Auditor) CPMA or Certified Evaluation and Management Coder CEMC required
• Certified Coding Specialist - Physician Based (CCS-P) - AHIMA, RHIT or RHIA preferred
• Valid California Driver's license

Salary Range:
$61.27 - $91.91 USD Hour
The Physical Requirements and Working Conditions of this job are available. El Camino Health will provide reasonable accommodations to qualified individuals with a disability if that will allow them to perform the essential functions of a job unless doing so creates an undue hardship for the hospital, or causes a direct threat to these individuals or others in the workplace which cannot be eliminated by reasonable accommodation.
Sedentary Work - Duties performed mostly while sitting; walking and standing at times. Occasionally lift or carry up to 10 lbs. Uses hands and fingers. - (Physical Requirements-United States of America)
An Equal Opportunity Employer:
El Camino Health seeks and values a diverse workforce. The organization is an equal opportunity employer and makes employment decisions on the basis of qualifications and competencies. El Camino Health prohibits discrimination in employment based on race, ancestry, national origin, color, sex, sexual orientation, gender identity, religion, disability, marital status, age, medical condition or any other status protected by law. In addition to state and federal law, El Camino Health also follows all applicable fair and equitable employment policies from the County of Santa Clara.