Medical Records Coder II/III - Correctional Health (Open & Promotional)

County of San Mateo•San Mateo, CA

8d•Hybrid

About The Position

San Mateo County Health is seeking an experienced Medical Records Coder II/III to join Correctional Health and support the coding of CalAIM billable services, including clinic visits and ancillary services. This position plays an important role in ensuring accurate reimbursement while supporting continuity of care for justice-involved individuals. The successful candidate will perform billing functions related to the Department of Health Care Services (DHCS) Justice-Involved CalAIM Initiative. This initiative allows eligible incarcerated individuals to enroll in Medi-Cal prior to their release and enables reimbursement for covered healthcare services provided during the 90 days before reentry, helping support successful transitions back into the community. This position requires independent proficiency in ICD-10 and CPT coding, coding audits, physician education on coding practices, Evaluation and Management (E/M) coding, and identifying and resolving billing edits. This assignment primarily focuses on professional fee (profee) coding, with the majority of work involving outpatient clinic visits. Additional assignments may include other professional fee chart types. A strong understanding of ICD-10/CPT coding guidelines, code combinations, and documentation requirements is essential for success. Initial training will be provided onsite in the Health Information Management Department in San Mateo. Following training, the successful candidate will primarily work in the adult correctional facilities in Redwood City and/or the Youth Services Center in San Mateo. Remote work options may be available based on operational needs.

Requirements

Possession of at least one (1) of the following certifications: Certified Coding Specialist (CCS) issued by the American Health Information Management Association (AHIMA), Registered Health Information Technician (RHIT) issued by the American Health Information Management Association (AHIMA), Registered Health Information Administrator (RHIA) issued by the American Health Information Management Association (AHIMA), Certified Professional Coder-Hospital (CPC-H) issued by the American Academy of Professional Coders (AAPC), Certified Professional Coder (CPC) issued by the American Academy of Professional Coders (AAPC).
Knowledge of ICD10 and CPT classification coding systems.
Knowledge of Fundamentals of anatomy, physiology, and the study of diseases.
Knowledge of Extensive medical terminology, and hospital accreditation and regulatory standards.
Knowledge of ICD10 coding guidelines and Ethical Coding standards.
Knowledge of NCCI edits and hospital modifiers (for the journey level Coders).
Knowledge of Standard clerical office procedures and equipment including Windows-based software use.
Competently select ICD10 to code diagnoses, treatments and procedures for outpatient or inpatient services either by use of coding books or encoder products.
Competently code procedure using CPT logic.
Abide by the standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official coding guidelines.
Maintain Continuing Education for certifications
Abstract pertinent information from medical records.
Follow oral and written instructions.
Operate computer and appropriate coding software and abstract package.
Effectively communicate technical information to medical and administrative personnel.
Maintain effective working relationships with others.
Three years of experience in coding hospital related services (for II level).
Three years of coding inpatient records (for III level).

Nice To Haves

Experience with Medi-Cal, Medicaid, Medicare, or another government healthcare payer.
Experience with the CalAIM Justice-Involved Reentry Initiative or another complex public healthcare reimbursement program.
Experience coding services in correctional health, community health, behavioral health, substance use treatment, or another integrated healthcare setting.
Experience using Epic coding, charge review, claim edit, or revenue cycle work queues.
Knowledge of Impact of illness severity on CC/MCC assignments (for III level).
Knowledge of MS-DRG assignment and complex comorbidities (for III level).
Knowledge of Governmental regulations pertaining to billing and coding (for III level).
Ability to Assign appropriate evaluation/management level for professional services (for III level).
Ability to Analyze and resolve billing edits (for III level).

Responsibilities

Independently review clinical documentation and assign accurate ICD-10-CM, CPT, HCPCS Level II, Evaluation and Management (E/M), and modifier information for outpatient professional-fee services while applying official coding guidelines, National Correct Coding Initiative (NCCI) edits, payer requirements, and County coding policies.
Review coding work queues, claim edits, denials, and unresolved accounts; identify coding, documentation, workflow, or system issues; and take timely action to resolve billing discrepancies.
Collaborate with providers and clinical staff to clarify documentation, provide coding education, and promote accurate, complete clinical documentation.
Conduct prospective and retrospective coding audits, identify error trends, document findings, and recommend corrective actions.
Monitor coding inventory, aging accounts, audit findings, productivity, accuracy, quality, and turnaround-time expectations.
Maintain current knowledge of ICD-10-CM, CPT, HCPCS, E/M guidelines, Medi-Cal requirements, CalAIM policies, and other applicable regulations.
Collaborate with Correctional Health, Health Information Management, Patient Financial Services, clinical departments, Epic support teams, and other County partners to improve coding procedures, documentation practices, educational resources, and standardized workflows.
Maintain patient confidentiality and comply with all privacy, information security, and correctional facility requirements.
Perform related duties as assigned.
Assign or verify correct International Classification of Diseases Clinical Modification System and Current Procedural Terminology (ICD10/CPT) codes to outpatient or inpatient medical records.
Utilize technical coding principles and APC reimbursement expertise to assign appropriate ICD-10-CM diagnoses and ICD-10-CM/CPT procedures.
Review narrative records of patient treatments and surgical procedures to determine what information is appropriate for coding purposes and prepare case abstracts.
Enter coded medical records data on computer terminal; select diagnosis and operations codes from computer designated abstracting system.
Assist in implementing solutions to reduce back-end billing errors.
Track weekly and follow up on all accounts that cannot be coded.
Contact doctors, nurses, laboratory and other auxiliary personnel for information needed to complete, correct or clarify medical records and to resolve discrepancies.