Company Intro: Ocean Health Initiatives, Inc. (OHI) is a Federally Qualified Health Center (FQHC) dedicated to providing quality, accessible and comprehensive primary health care to the residents of Ocean and Monmouth County; regardless of economic status.

Our Health Center Locations: Brick, Freehold, Lakewood, Little Egg Harbor, Manahawkin, Manchester and Toms River; with our school-based Wellness Programs located within the Clifton Ave Grade School, Lakewood; and Lakewood High School.

OHI services include family and internal medicine, pediatrics, behavioral health, nutrition, OB/GYN women’s health, dental, family planning, specialty care, pharmacies, PrEP, and a STI clinic.

Hours: Full-time hours are M-F 8:00am- 4:30pm with rotating evening/Saturday shifts (subject to seasonal changes and business/site needs)

Position Summary

Reporting to the Billing Manager, the Clinical Coder is responsible for the daily coding of assigned encounters ensuring that claims coding is accurate and compliant. Reviews Provider medical documentation and translates into diagnosis and procedure codes used for claims creation, billing. and revenue cycle initiatives.

Responsibilities

• Reviews provider medical record documentation and assigns appropriate procedure, diagnosis and HCPCS codes based on services rendered for accurate billing.
• Reviews provider medical record documentation to ensure compliance with established CMS/AMA documentation requirements for CPT edits.
• Complies with medical coding guidelines and policies to ensure OHI’s compliance.
• Identifies payer trends and policy changes for quick resolution.
• Tracks payer denials. Reviews, corrects and appeals claims for payer reimbursement reconsideration.
• Queries providers when code assignments are unclear or conflicting to ensure accurate billing.
• Posts contractual adjustments.
• Assists other department staff with coding questions when needed.
• Identifies education opportunities for department staff to reduce errors and optimize coding practices.
• Creates and prepares claims for electronic submission daily. Prints and mails claim as needed.
• Assists patients with account balance questions or concerns. Answers all billing, patient and insurance inquiries.
• Performs chart audits.
• Understands the departments Key Performance Metrics, strives to meet and maintain performance goals.
• Maintains a monthly successful scorecard 80% or higher.
• Manual input of charges.
• Completes assigned tasks in a timely manner.
• Maintains proficiency in Billing Platform and EMR.
• Assists in other financial or billing related issues.
• Completes all mandatory in-services and attends required meetings.
• Is highly accountable for one's own productivity. In order to maintain transparency, all projects must be represented clearly on a project board in Monday.com. Responsible for ensuring the board is always updated and accurate and that information is accessible to those that need it.
• Adheres to Corporate Compliance policies.
• Other duties as assigned.

Education/Experience/Licensure

• High School diploma or equivalent required.
• Nationally recognized Coding Certification is required of all coders.
• Medical Billing Certification is preferred or relevant years of experience.
• One to two years of experience in billing department in medical center, private physician’s office, or other applicable healthcare setting.
• Bi-lingual (English/Spanish) is preferred.
• Proficiency in Microsoft Office 365 is required.

Benefits:

• Paid Time Off (PTO)
• Holidays (8)
• Health Insurance
• Dental Benefits
• 401(k) + 5% match
• Group Term Life Insurance
• Flexible Spending Account

Pre-Employment Requirements:

• Physical
• Criminal Background Checks
• Drug Screening
• Tuberculosis Screening

Ocean Health Initiatives is firmly committed to creating a diverse workplace and is proud to provide equal employment opportunities to all applicants. Therefore, Ocean Health does not discriminate on the basis of creed, color, national origin, sex, gender identity, sexual orientation, age, religion, marital or parental status, alienage, disability, political affiliation or belief, military or military discharge status.

In accordance with New Jersey Executive order (COVID-19 No.283) in conjunction with the Federal CDC guidelines, COVID vaccinations are a requirement for Ocean Health Initiatives as well as many other Healthcare Organizations. Proof of full vaccination and the booster shot is required prior to the beginning date of employment. If you have a medical or religious contraindication, please inform Human Resources when the offer is extended.