Cms Gov Jobs in California (NOW HIRING)

POSITION SUMMARY: Supports daily billing and coding operations by coordinating workflows, monitoring productivity and ensuring accuracy, compliance, and timely claim submission. This role supervises staff, provides training, resolves routine issues, and escalates complex matters to management.

ESSENTIAL FUNCTIONS:

· Monitors daily production, quality, and adherence to department standards regarding billing operations, coding, and compliance for the timely submission of clean claims

· Identifies performance trends and recommends improvements

· Provides training and education related to regulatory and billing requirements

· The training and education responsibilities of this position include contributing to training material development, instructing current coders and coder trainees about coding guidelines, code changes and observed issues from the audits

· Serve as a resource for staff on billing and coding issues, offering guidance and solutions

· Collaborates with other departments to include operations, eligibility, and collections to identify and resolve issues impacting billing or coding.

Key Responsibilities:

Team Leadership & Staff Development

· Provide leadership and development to the coding team members, fostering a positive and productive work environment

· Identify training needs and coordinate ongoing education opportunities to improve team expertise and capabilities

· Develop and present educational tools and procedures for billers and coders

· Actively contribute to designing and developing training modules related to medical coding, documentation, physician queries, and EHR abstracting

· Stay updated with company policies, procedures, and practices; participate in ongoing training and development to ensure skills remain current and comprehensive

· Coordinate daily tasks and provide support to onshore and offshore billing and team members

Operational Oversight & Workflow Coordination

· Exercises independent judgment on day-to-day operational matters; escalates complex, strategic, or cross-functional issues to the Manager or Director

· Supervise and coordinate all daily billing and coding activities

· Assist with weekly and month-end billing and charge reporting by preparing data and coordinating team completion

· Establish and maintain positive working relationships across departments, divisions, and locations to support operational efficiency

· Assist with coding inquires from other departments and providers

· Strong analytical ability to convert data into action

Quality Assurance, Compliance & Continuous Improvement

· Conduct audits and reviews of coding processes to ensure adherence to regulatory standards and best practices

· Stay current with industry trends, regulations, and updates to coding guidelines to support continuous improvement

· Proactively identify workflow enhancement opportunities and collaborate with management to implement improvements

Project Leadership & Strategic Support

· Lead special projects as assigned or identified through personal initiative, contributing to departmental improvement efforts

Required:

•  A High School Diploma or equivalent
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification
• Minimum 3 years direct leadership experience of more than 5 people
• Minimum of 3 years’ experience with as a medical coder
• Extensive knowledge of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), International Classification of Diseases-10 (ICD-10), Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs), Internet Only Manual (CMS.gov), and the National Correct Coding Initiative (NCCI)., payor policies, etc.)
• Moderate ability in Microsoft Excel and Microsoft Office
• Strong research skills to maintain current knowledge of regulatory changes
• Effective oral and written communication
• Legal eligibility to work in the United States without sponsorship now or in the future
• Ability to successfully pass a background investigation / pre-employment screening
• Preferred
• Podiatry or lower body orthopedic experience
• Experience with California IPAs

(Any combination of academic education and professional training and development along with applied work experience that demonstrates the ability to successfully perform the essential functions of the position will be considered)