Billing & Coding Specialist (Administrative)
Position Overview
A successful Billing & Coding Specialist must be passionate about healthcare and driven to make a difference in the lives of others, serving as a mission-focused catalyst to help Livingston Community Health deliver the highest quality of care and exceptional service to our patients and their families.
The Billing & Coding Specialist ensures accurate, timely coding and billing of all patient encounters in accordance with FQHC regulations, payer requirements, and organizational policies. By maintaining compliant billing practices, the role supports LCH's financial sustainability and ability to provide affordable care to our community.
Essential Functions, Duties, and Responsibilities
Coding & Documentation
Review clinical documentation; assign appropriate ICD-10-CM, CPT, and HCPCS codes (including modifiers).
Clarify missing or ambiguous information directly with providers and clinical staff.
Claim Preparation & Submission
Prepare and submit clean claims to Medicare, Medicaid, Managed Care Organizations, and commercial insurers under PPS/APM guidelines.
Verify patient eligibility and benefits when necessary.
Denial Management
Monitor electronic remittance advice (ERA); investigate and resolve denials within established turnaround times.
Trend denial data and recommend process improvements to reduce future occurrences.
Regulatory Compliance
Maintain current knowledge of FQHC billing rules (sliding fee, UDS, PPS rate updates) and payer-specific policies.
Adhere to HIPAA privacy/security and all relevant federal, state, and local regulations.
Reporting & Analysis
Generate monthly, quarterly, and annual billing metrics (e.g., days in A/R, denial rate).
Assist in UDS, OSHPD, and other mandated cost reports; support internal and external audits.
Process Improvement & Collaboration
Partner with the Director of Revenue Cycle and Chief Medical Officer on coding setups for new services.
Provide coding education to providers and staff and serve as the department's subject-matter expert.
Operational Support
Respond promptly to provider and patient inquiries with exceptional customer service.
Supports the overall needs of the organization by working flexible or extended hours when necessary.
Demonstrates competence with the mission, vision, and values of the organization in providing quality services to the community.
Other work-related duties as assigned. Duties and responsibilities may be added, deleted, or changed at any time at the direction of leadership, formally or informally, either verbally or in writing.
Maintains confidentiality and respect for all sensitive information.
Displays a positive, professional, and respectful demeanor at all times towards employees, peers, professional contacts, and patients served, maintaining a professional appearance and positive image for LCH.
Contributes as part of the finance team by promoting positive staff interactions and maintaining open communication with other programs and departments.
Attends and actively participates in all meetings (e.g., department meetings, program meetings, staff meetings) and other activities as required or assigned.
Education, Knowledge, Skills, and Abilities
Education and Experience
Must possess a high school diploma or equivalent.
Associate's degree in Health Information Management or related field is preferred.
1 -3 years of hands-on medical billing experience in an FQHC or similar healthcare setting required, including medical coding experience using CPT, ICD-10-CM, and HCPCS.
Certifications
Current CPC, CCS, or equivalent professional coding credential required.
Knowledge, Skills, and Abilities
Proficiency with EHR/Practice Management systems (eClinicalWorks, NextGen, or similar).
In-depth knowledge of CPT, ICD-10, HCPCS, modifier usage, and payer billing requirements.
Working knowledge of FQHC PPS/APM methodologies, sliding-fee discount programs, and UDS reporting.
Strong analytical, problem-solving, and organizational skills; high attention to detail.
Effective written and verbal communication; ability to convey complex coding concepts to non-coders.
Proficiency in Microsoft Office (Word, Excel) and ability to learn new software quickly.
Proficient in medical terminology and healthcare documentation.
Ability to work successfully as part of a team.
Willingness to communicate using strong emotional intelligence.
