Billing & Coding Specialist

The HealthCare Connection•Cincinnati, OH

About The Position

The Billing & Coding Specialist is responsible for accurate coding, charge review, risk‑adjustment support, and claims coordination within an FQHC environment. This role facilitates communication and workflows with the third‑party billing company, ensures compliance with FQHC billing requirements, supports providers with documentation improvement, and participates in revenue cycle special projects.

Requirements

High school diploma required; associate degree in health information, billing, or related field preferred.
Certified coder required (CPC, CCS, or equivalent).
Experience or training in risk‑adjustment coding; CRC preferred or willingness to obtain within 12 months.
Minimum 2 years of medical billing and coding experience; FQHC experience strongly preferred.
Knowledge of CPT, HCPCS, ICD‑10, PPS/GFQHC 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

Risk‑adjustment coding certification (CRC).
Experience coordinating with external billing vendors.
Experience with NextGen and EPIC.

Responsibilities

Perform coding review of encounters to ensure accurate CPT, HCPCS, and ICD‑10 coding in compliance with payer and FQHC rules.
Ensure accurate capture of risk‑adjusting diagnoses (HCC) and communicate documentation needs to providers.
Conduct ongoing coding audits and maintain documentation of findings, trends, and corrective action steps.
Collaborate with the third‑party billing company to resolve coding‑related denials, edits, and claim rejections.
Assist in monitoring A/R trends, denial rates, and vendor performance metrics.
Review charge data for completeness, accuracy, and compliance prior to 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.
Develop and host coding and documentation training sessions for providers and clinical staff to improve coding accuracy, documentation quality, risk-adjustment capture, and compliance.
Ensure adherence to HRSA, UDS, Medicaid/Medicare, HIPAA, and other regulatory requirements.