Billing & Coding Analyst

Healthcare Connection•Cincinnati, OH

17h•Hybrid

About The Position

The Billing & Coding Analyst supports accurate coding, charge review, risk-adjustment, and claims coordination within an FQHC environment. The role coordinates workflows with the third-party billing company, supports compliance with FQHC billing requirements, provides documentation guidance to providers, and participates in revenue cycle projects. The position also supports accounts receivable monitoring, month-end coding reconciliation and reporting, claim follow-up, patient account maintenance, and processing adjustments and refunds. The analyst reviews encounters and charge data for accuracy and compliance with payer and regulatory requirements, and works with front desk staff and the billing vendor to address patient balances and aging accounts.

Requirements

High school diploma required; an associate degree in health information, billing, or a related field is preferred.
Certified coder required (CPC, CCS, or equivalent).
Experience or training in risk-adjustment coding; CRC certification is preferred, or willingness to obtain it within 12 months.
At least 2 years of medical billing and coding experience; FQHC experience is strongly preferred.
Knowledge of CPT, HCPCS, ICD-10, PPS/FQHC billing rules, Medicaid, Medicare, and commercial payer requirements.
Strong communication skills, attention to detail, and ability to collaborate with clinical, administrative, and external teams.
Proficiency with EHR and billing software systems.

Nice To Haves

Associate degree in health information, billing, or a related field.
Risk-adjustment coding certification (CRC).
FQHC experience.
Experience coordinating with external billing vendors.
Experience with NextGen and EPIC.

Responsibilities

Collaborate with the third-party billing company to resolve coding-related denials, edits, and claim rejections.
Assist in monitoring accounts receivable trends, denial rates, and vendor performance metrics.
Review charge data for completeness, accuracy, and compliance before submission.
Support month-end close activities, including coding reconciliation and reporting.
Participate in special projects such as workflow redesign, EHR template optimization, payer audits, and regulatory updates.
Provide coding and documentation guidance to providers and clinical departments.
Follow up on outstanding claims.
Generate reports and respond to inquiries about entered data, including monitoring unsigned notes.
Maintain patient accounts that have been sent to collections.
Ensure adherence to HRSA, UDS, Medicaid, Medicare, HIPAA, and other regulatory requirements.
Review encounter coding to ensure accurate CPT, HCPCS, and ICD-10 coding in compliance with payer and FQHC rules.
Ensure adjustments and refunds are processed and accounts are updated appropriately.
Review and initiate refunds for overpayments identified through third-party billing company audits.
Review aging reports and work with the third-party billing company to reduce aging balances.
Review patient balances with front desk staff so they can contact patients.