Coding Integrity Specialist Jobs in Riverside, CA

The Billing and Coding Specialist ensures the accurate and compliant coding and billing of medical, dental, and behavioral health services within a Federally Qualified Health Center (FQHC). This position supports revenue cycle operations under the Billing Manager by translating clinical documentation into billable codes and ensuring timely, clean claim submission to payers including Medicare, Medi-Cal (Fee-for-Service and Managed Care), commercial and PPO plans, and commercial dental plans.

This dual-function role also integrates claims processing and eligibility interpretation, with regular use of tools such as MedPoint, the DHCS (Medi-Cal) portal, and health plan portals, in addition to the electronic health record for billing workflows. IBHS is transitioning to Epic, so comfort adapting to new systems is valued.

Schedule: 5 days per week, 8 hours per day, Monday - Friday (with a rotating Saturday as needed)

Shifts: 8:00 – 5:00pm, 9:00 – 6:00pm, and 10:00 – 7:00pm

Locations: San Bernardino, CA

ESSENTIAL FUNCTIONS AND DELIVERABLES

• Medical Coding & Documentation Review
• Accurately assign ICD-10, CPT, and HCPCS codes to medical and behavioral health encounters.
• Assign CDT codes for dental encounters.
• Apply FQHC-specific billing codes (T1015, G0466–G0470) and appropriate modifiers.
• Apply behavioral health coding and payer rules specific to FQHC settings.
• Audit provider documentation for coding integrity; query providers when clarification is needed.
• Claims Processing & Charge Entry
• Review and validate encounter charges.
• Submit clean claims through the health center’s clearinghouse and correct claim or edit rejections promptly.
• Monitor billing work queues and clearinghouse dashboards to prevent submission delays.
• Eligibility Interpretation & Portal Usage
• Interpret coverage and aid codes using IPA portal, the DHCS portal, and payer portals (e.g., IEHP, Availity).
• Confirm eligibility for self-pay, Medi-Cal, commercial/PPO, and commercial dental plans prior to claim submission.
• Work with front office and billing staff to resolve eligibility mismatches and demographic errors.
• Denial Prevention & Resolution
• Analyze claim denials related to coding, eligibility, or system errors.
• Take corrective action to re-code and resubmit denied claims.
• Document trends and escalate recurring issues to management.
• Compliance & Audit Support
• Maintain adherence to CMS, HRSA, and payer-specific coding guidelines.
• Support coding accuracy that underlies UDS reporting and internal quality reviews.
• Support audit requests and Operational Site Visit (OSV) preparation.
• Apply Sliding Fee Discount Program guidelines when applicable.
  

QUALIFICATIONS

• Education: High school diploma or GED.
• Experience: Minimum 2 years of experience in medical billing and/or coding.
• Essential Technical/Motor Skills: Proficiency in ICD-10, CPT, and HCPCS coding. Experience interpreting eligibility through payer portals (e.g., DHCS, payer websites). Computer literate with knowledge and experience with specific software such as Word, Excel, Access. Must have proficient computer skills including data entry (35wpm). Must be able to use a variety of office equipment including fax machine, scanner, printer and copier.
• Essential Mental Abilities: Requires critical thinking skills. Strong attention to detail, time management, and organizational skills.
• Interpersonal Skills: Ability to troubleshoot independently. Skilled in working independently, but with supervision. Must have professional telephone etiquette combined with a pleasant and courteous voice. Fluency in English required. Must possess the ability to maintain a professional attitude in difficult situations and communicate effectively across teams. Must perform as a team player.
• Work Eligibility: Must be legally authorized to work in the United States on a full-time basis.
  

PREFERRED QUALIFICATIONS

• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS); or Medical Billing Certification.
• Experience in an FQHC or community health setting, including PPS billing.
• Familiarity with Medi-Cal (FFS and Managed Care), Medicare, commercial, and PPO payer rules.
• Experience with dental (CDT) and behavioral health coding.
• Comfortable working in Electronic Health Records (EHR); Epic experience a plus.
• Skilled in interpreting DHCS, and payer eligibility portals.
• Bilingual (English/Spanish).
• Familiarity with California-specific Medi-Cal programs.
  

PHYSICAL REQUIREMENTS & WORK ENVIRONMENT

Prolonged periods of sitting and working at a computer. Occasional lifting of up to 15 pounds. Work is performed on-site in an office/clinic environment. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the ADA.

EQUAL EMPLOYMENT OPPORTUNITY

Inland Behavioral and Health Services, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status, or any other characteristic protected by applicable law.

Universal Requirements:

Pre-employment requirements include I-9, positive background and reference check results, complete application, new hire orientation, and drug screening and completion of employee health screening.

If you are passionate about supporting community health initiatives through meticulous data management, we invite you to apply today and become a part of our dedicated team at Inland Behavioral and Health Services.