Ambulatory Professional Fee and Hospitalist Coder (Full Time)

NorthBay Healthcare Group; Fairfield (CA); On-site; USD 85,000 - 110,000; Full time

Job summary

NorthBay Health seeks an experienced Medical Coder to translate procedures and diagnoses into ICD-10, CPT and HCPCS codes in a hospital setting. You will work with providers to ensure accurate documentation, query as needed, and abstract demographics for reporting within our hospital systems.

The ideal candidate has strong knowledge of coding guidelines, EMR/encoder experience, and the ability to work independently or as part of the CDI team, while adhering to HIPAA and regulatory standards.

Qualifications

• Five+ years multi-specialty professional fee hospital coding experience.
• Proficiency with ICD-10, CPT, HCPCS and E/M guidelines.
• Experience with encoder and EHR/abstracting systems.

Responsibilities

• Code inpatient records with CPT, ICD-10, and HCPCS per guidelines.
• Query providers to ensure accuracy and maximize reimbursement.
• Abstract demographic data for regulatory reporting.
• Use EHR and encoding systems to perform duties.
• Provide documentation education to physicians.
• Collaborate with CDI program as needed.

Skills

Metrics-oriented

Tech savvy

Education

High school diploma or equivalent

Tools

Encoder system

EMR system

Cerner

Microsoft Office

Job description

Job Description

At Northbay Health, the Coder will play a crucial role in accurately translating medical procedures and diagnoses into ICD 10, CPT and HCPCS codes in an accurate and timely manner in the hospital setting. Our ideal candidate is a dedicated, knowledgeable individual with a strong understanding of medical terminology, coding guidelines, regulations, and proficiency in utilizing an EHR/encoder system. Can effectively communicate with providers via email, query, phone call or in person to educate or discuss coding requirements. Abstracts demographic and physician data to meet both internal and regulatory requirements for reporting utilizing the hospital's abstracting system. Work is performed using the approved classification Coding systems to include the modifiers. All work carried out in accordance with the rules, regulations and coding conventions of the AAPC/AMA CPT Guidelines, AAPC/AMA. American Hospital Association (Coding Clinic), ICD 10-CM CMS, HCAI, and NorthBay Healthcare coding guidelines.

Primary Job Duties

• Independently performs coding of patients' inpatient records to ensure accurate assignment of physician, professional fee, surgical, and other hospital-based services using the most appropriate CPT, ICD-10, and HCPCS codes in accordance with CMS, Coding Clinic, and other regulatory guidelines. Adds modifiers as appropriate to maximize reimbursement and reduce denials.
• Must have experience working in a multi-specialty environment and assigning physician Evaluation and Management (E&M) levels.
• Collects visit information, analyzes documentation, identifies discrepancies, and queries providers as needed to ensure the accuracy and integrity of reviewed data.
• Utilizes the electronic health record (EHR), abstracting systems, encoding systems, and computer-assisted coding systems to perform job responsibilities.
• Ensures coding is accurate and sequenced correctly in compliance with coding guidelines, government regulations, and payer requirements.
• Maintains current knowledge of coding requirements and compliance guidelines based on assigned specialty and departmental needs.
• Meets department productivity and quality standards for coding performance.
• Abstracts designated demographic data into the medical record abstracting system to satisfy internal and external regulatory reporting requirements.
• Provides documentation education and support to physicians to ensure coding assignments comply with regulatory requirements.
• Collaborates with the Clinical Documentation Integrity (CDI) program as needed.
• Responds to audit reviews and addresses findings in a timely manner.
• Provides timely feedback to the Manager, Professional Fee Coding, regarding operational issues and escalates recurring concerns as appropriate.
• Partners with Business Office staff to resolve billing and coding issues and corrects pending diagnoses or suspended reports as needed.
• Keeps management and applicable departments informed regarding completed work, backlogs, physician education activities, and other assigned responsibilities through designated tracking tools.
• Maintains required coding certification and pursues ongoing professional development through educational programs, seminars, and related learning opportunities.
• Adheres to HIPAA policies and procedures to maintain patient confidentiality and protect all health information.
• Complies with organizational policies and procedures, safety standards, Joint Commission (TJC) standards, and all applicable regulatory requirements.
• Demonstrates the True North Values of Nurture/Care, Own It, Respect Relationships, Build Trust, and Hardwire Excellence.
• Reports to the office as required and understands that failure to meet regulatory accuracy standards may result in a return to an in-office work environment.
• Performs other duties and responsibilities as assigned.

Qualifications

Education

• High School Graduate or equivalent preferred.

Licensure

• Certified Professional Coder (CPC), Certified Coding Specialist - Physician (CCS-P), Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA).

Experience

• Five or more years of continuous experience in Multi-specialty Profee Hospital and clinical coding required.
• EMR Medical records experience is required.
• Experience with an encoder system preferred.
• Comprehensive knowledge and application of profee E&M guidelines for physician inpatient coding and billing.
• Demonstrated knowledge of anatomy and physiology, medical terminology, disease process, reimbursement methodologies (DRGs, HCCs, APCs), and the conventions, rules and guidelines for current coding classification (ICD10-CM, CPT and HCPCS).
• Demonstrated understanding of the clinical content of a health record.
• Knowledge of and experience with PC's, Cerner, and/or computer systems and programs highly desired.
• Microsoft Office: Email, Word, Excel.
• Has a comprehensive understanding of insurance requirements and compliance guidelines for Medicare, PHP, WHA and Medi-Cal, Work's Compensation, Commercial Insurances.
• Ability and self-discipline to be able to work remotely.
• Ability to withstand the pressure of continual deadlines and receipt of work with variable requirements.
• The ability to work independently as well as in a team environment.

Skills

• Ability and desire to hit metrics upon training (idle time is also monitored on this hourly paid position).
• Technically savvy (ability to learn software and troubleshoot equipment as needed).

Standards of Performance

• Demonstrate performance by adhering to established policies and procedures and exhibiting the defined characteristics associated with attendance and punctuality.

Physical Effort

• Attendance is an essential function of the job.
• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Ability to sit for long periods of time.
• Ability to lift, push or pull 5 pounds.
• Occasional bending, stooping, crouching, reaching.
• Ability to concentrate and maintain accuracy despite frequent interruptions.
• Keyboarding skills.

Hours of Work

• Full Time Days Monday through Friday as assigned based on business need.
• Timing may also be at discretion of leadership based on business need.

Other Requirements

• Must have a private, distraction-free area in your home for working (HIPAA reasons).
• Web-cam training will be used frequently for team engagement.
• Internet Requirements: Must have high speed internet.
• Please test your internet prior to applying to make sure you are over 125 mbps download speed or be willing to upgrade upon an offer.

About Us

Interpersonal Skills and Values

Demonstrates NorthBay Health's True North Values: Nurture Care, Own It, Respect Relationships, Build Trust, and Hardwire Excellence. These values guide behavior, accountability, teamwork, and commitment to high-quality patient care.

Why NorthBay Health

NorthBay Health is an independent, nonprofit health system serving the Napa, Solano, and Yolo County regions. We are expanding access to care across our communities through two acute-care hospitals, including a Level II Trauma Center and a Level III NICU maternity unit, along with a cancer center, urgent care locations, and a growing network of primary and specialty care clinics.

We provide advanced services in cardiovascular care, neuroscience, orthopedics, surgery, and outpatient specialties. NorthBay Health is nationally recognized for quality care, including Magnet with Distinction designation for nursing and multiple U.S. News and World Report high performing recognitions.

We are committed to being the trusted healthcare partner of choice and offer an environment where employees can grow, contribute meaningfully, and support the health of our communities.

NorthBay Health Benefits Options

NorthBay Health offers a comprehensive benefits package based on established eligibility requirements. Benefits may include medical, dental, and vision insurance, life, disability, and long-term care coverage, paid time off including vacation, sick leave, holidays, and bereavement, a 403(b) retirement plan with employer match, education reimbursement for eligible roles, professional development and training programs, Employee Assistance Program, wellness programs, recognition programs, shift differentials, and market-based compensation review and increases subject to approval and organizational performance.

Compensation Structure

NorthBay Health uses a structured compensation framework. Staff-level positions use a step-based system (Steps 1-5) based on years of directly related experience, with Step 5 representing 20 or more years of experience in the role. Manager level and above positions are paid a fixed annual base salary and are eligible for a variable incentive compensation plan. Physician compensation is structured based on specialty and role requirements.

Remote Work Disclosure

NorthBay Health is primarily an onsite organization due to the nature of healthcare. Some roles may allow hybrid or remote work based on business needs.

Remote work is not supported in Washington, Ohio, Wyoming, North Dakota, Puerto Rico, the U.S. Virgin Islands, or outside of the United States.

Notice to Recruitment Agencies

NorthBay Health utilizes a managed service provider (MSP) for agency partnerships and is not currently engaging external recruiting firms outside of established agreements. We do not accept unsolicited resumes or third-party candidate submissions. Please do not contact NorthBay Health employees, leaders, physicians, or hiring managers regarding recruitment or job postings.

More Information

Visit NorthBay Health Careers for recruitment FAQs and additional information.