Company: Cal Med Physicians and Surgeons, Inc. Location: Redlands, CA (Off-site location) Position Summary: The Medical Billing and Coding Specialist utilizes knowledge of insurance regulations, health insurance contracts, medical coding, and bookkeeping to perform a variety of revenue cycle support activities. These include but are not limited to medical coding, insurance verification, ensuring the accuracy of the information housed in the practice management system, preparing deposits, collecting, posting, and managing account payments, submitting accurate claims, and following up on accounts. Supervision Received: There are two (2) floor supervisors, along with an office manager; all employees are direct reports to the company's Chief of Staff. Pre-Employment Process: Candidates selected for this position must pass a background investigation and verification of employment history and education. Shift: Monday - Friday; 8:00 a.m. - 5:00 p.m. Desired Qualifications: High School Diploma, GED, or suitable equivalent. Coding Certification from APPC or AHIMA. Minimum of one (1) year work experience as a Medical Billing Specialist; with knowledge of the 2024 CPT code updates. Strongly Preferred: Minimum five (5) years medical coding work experience working in healthcare; two (2) years medical coding/billing work experience within Surgical groups. Knowledge of general accounting principles, revenue cycle processes, medical insurance, and associated regulations. High degree of accuracy and attention to detail. Ability to manage multiple tasks/projects, and deadlines simultaneously and to identify and resolve exceptions and to interpret data; proficient in data entry. Customer service orientation and negotiation skills, including the ability to interface with third party payers. Excellent communication skills, both verbal and written. Proficient computer skills, including Microsoft Office applications. Bilingual (Spanish is preferred, with the ability to read, write, and speak proficiently). Essential Functions: Medical Coder Responsibilities: Extracts relevant information from patient records and acts as liaison with off-site medical billing clerk, providers, and supervisors to clarify information. Examines documents for missing information; corrects information as needed with approval from treating provider. Assigns CPT, HCPCS, ICD-10-CM, and DRG codes. Performs patient chart audits and provides coding feedback and education to clinical team as needed, with supervisors cc'd to communication. Answers questions and works with assigned providers/specialty to ensure accurate codes are being utilized appropriately. Ensures compliance with medical coding policies and guidelines; understands the application of each code set. Maintains current knowledge regarding coding and diagnostic procedures; especially as codes will be updated again in 2025 and were just updated in January of 2024. Works towards compliance in all aspects of coding, participates in compliance activities as requested, and conducts/participates in provider coding reviews and education, as requested. Medical Billing Specialist Responsibilities: Maintains practice management system by entering accurate data, verifying and updating insurance and claims information, handles carrier correspondence, manages EOBs. Prepare, review, submit, and follow up with clean claims to various companies/individuals. Investigates rejected claims to see why denials were issued and correct claims within the timeline period, while closely working with the provider associated with specific claim(s). Facilitate swift payment of invoices due to the organization by sending patient invoices, billing reminders, and making collection calls on outstanding balances as directed by supervisor. Completes Claims Center daily tasks including charge review and claims inspector; creates and maintains custom claim edits and works the client action worklist. Reviews and provides RCM weekly and monthly reports including productivity and financial reports as directed and completes action steps as necessary. Follows HIPAA guidelines when accessing and sharing patient information. Maintains patient and business confidentiality. Provides timely and professional customer service, verify discrepancies by and resolve patient billing issues, answer questions from patients, facility staff, and third-party vendors. Supports additional coding, billing, and practice management projects as needed. All other duties as assigned Physical/Mental Demands and Work Environment: Requires sitting and standing associated with a normal office environment. Performs highly complex and varied tasks requiring independent knowledge and its application to a variety of situations, as well as exercising independent judgement. Requires the use of office equipment such as copiers, scanners, computers, telephones, and fax machines. May view computer screens for long periods of time. Must be able to prioritize activities when faced with competing demands. The 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 job functions. Full-time position offers: Competitive Salary (Dependent on qualifications). Health benefits (medical; with dental and vision opt-ins) for employee and family. 401K with employee and employer contribution. Accrued paid time off. 40 hours of sick time after probation period of 90-days. If you are interested in this position, please send the following items: Updated cover letter. Updated resume. Certifications, if applicable. Application Procedure: Applications will be accepted until the position(s) is filled. Please be sure the information provided is always current; it is your responsibility to update your personal information. EEO/ADA: Cal Med Physicians and Surgeons, Inc. is an Equal Employment Opportunity (EEO) and Americans with Disabilities Act (ADA) compliant employer, committed to providing equal employment opportunity to all employees and applicants. Veterans' Preference: Eligible veterans and their spouse or widow(er) may be awarded additional Veterans' Preference points. Please provide this information upon application submission/request; if provided/requested, instructions and information for Veteran's Preference points will be communicated to applicant. Job Type: Full-time Pay: $19.00 - $22.00 per hour Expected hours: 40 per week Benefits: 401(k) Dental insurance Health insurance Paid time off Schedule: 8 hour shift Day shift Monday to Friday Education: High school or equivalent (Required) Experience: medical billing and coding: 1 year (Required) Shift availability: Day Shift (Required) Ability to Commute: Redlands, CA 92373 (Required) Work Location: In person