Coder - Insurance/Billing/Chart Review

Providence Health & Services; Irvine (CA); Hybrid; USD 41,000 - 62,000; Full time

Job summary

Providence Medical Foundation is seeking a Coding Auditor to review patient care documentation for CPT/ICD coding accuracy and compliance with payer policies. The role requires AHIMA/AAPC certifications and 3+ years of coding and billing experience across multiple specialties.

The position is based in California with a hybrid work arrangement and an emphasis on accurate data and documentation improvement. You will collaborate with providers and care teams to ensure compliant, efficient coding

Qualifications

• Associate's Degree in Coding education in college setting or AHIMA/AAPC program, or work experience in medical offices.
• National Certification from American Academy of Professional Coders (AAPC) upon hire.
• National Certified Coding Associate - AHIMA upon hire.
• National Certified Coding Specialist - AHIMA upon hire.
• National Certified Coding Specialist - Physician - AHIMA upon hire.
• National Certified Documentation Improvement Practitioner - AHIMA upon hire.
• National Certified Health Data Analyst - AHIMA upon hire.
• National Registered Health Information Administrator - AHIMA upon hire.
• National Registered Health Information Technician - AHIMA upon hire.
• 3 years Professional Coding experience in HCC coding across multiple specialties.
• 3 years Physician/clinic billing experience.
• Experience with Microsoft Office (Word, Excel, Outlook).

Responsibilities

• Perform coding audits of patient care billing documentation to ensure adherence to CPT and ICD coding guidelines and payor policies.

Skills

HCC coding experience

Physician/clinic billing experience

Microsoft Office

Education

Associate's Degree in Coding education

National Certification from AHIMA (or AAPC)

AHIMA: Certified Coding Associate (CCA)

AHIMA: Certified Coding Specialist (CSS)

AHIMA: Certified Coding Specialist-Physician (CCS-P)

AHIMA: Certified Documentation Improvement Practitioner (CDIP)

AHIMA: Health Data Analyst (RHDS/RHIA)

AHIMA: Registered Health Information Administrator (RHIA)

AHIMA: Registered Health Information Technician (RHIT)

Tools

Microsoft Office Suite (Word, Excel, Outlook)

Job description

Description

Under direction of the Director Provider Network Performance, performs coding audits of patient care billing documentation to ensure adherence with CPT and ICD coding guidelines and federal, state, and commercial payor billing and payment policy for all services provided by Providence Medical Foundation.

Providence caregivers are not simply valued - they're invaluable. Join our team at Providence Medical Foundation and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we Providence know that to inspire and retain the best people, we must empower them.

Required qualifications

• Associate's Degree in Coding education in college setting or certified distance learning program such as that provided by AHIMA or AAPC. Or Work experience in medical offices (insurance, coding, billing, registration duties).
• Upon hire: National Certification from American Academy of Professional Coders. Or
• Upon hire: National Certified Coding Associate - American Health Information Management Association.Or
• Upon hire: National Certified Coding Specialist - American Health Information Management Association.Or
• Upon hire: National Certified Coding Specialist - Physician - American Health Information Management Association. Or
• Upon hire: National Certified Documentation Improvement Practitioner - American Health Information Management Association. Or
• Upon hire: National Certified Health Data Analyst - American Health Information Management Association. Or
• Upon hire: National Registered Health Information Administrator - American Health Information Management Association. Or
• Upon hire: National Registered Health Information Technician - American Health Information Management Association
• 3 years Professional (POS11) Coding experience in HCC coding, Primary Care, Oncology, Infusion, Neurology, OB/GYN, Cardiology, Endocrinology, Rheumatology, General Surgery.
• 3 years Physician/clinic billing experience.
• Experience with Microsoft Office (Word, Excel, Outlook)

Preferred qualifications

• Upon hire: Additional certifications (specialty coding certifications)
• Upon hire: Medical billing and coding certificate

Why Join Providence?

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

About Providence

At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.

Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

About the Team

Providence Clinical Network (PCN) is a service line within Providence serving patients across seven states with quality, compassionate, coordinated care. Collectively, our medical groups and affiliate practices are the third largest group in the country with over 11,000 providers, 900 clinics and 30,000 caregivers.

PCN is comprised of Providence Medical Group in Alaska, Washington, Montana and Oregon; Swedish Medical Group in Washington's greater Puget Sound area, Pacific Medical Centers in western Washington; Kadlec in southeast Washington; Providence's St. John's Medical Foundation in Southern California; Providence Medical Institute in Southern California; Providence Facey Medical Foundation in Southern California; Providence Medical Foundation in Northern and Southern California; and Covenant Medical Group and Covenant Health Partners in west Texas and eastern New Mexico.

Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.

Job Schedule: Full time

Job Shift: Day

Career Track: Admin Support

Department: 7520 POPULATION HEALTH REGIONAL CA HERITAGE SERVICES

Address: CA Anaheim 200 W Center St Promenade

Work Location: St Joseph Home Health-Anaheim

Workplace Type: Hybrid

Pay Range: $29.62 - $45.31

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.