Risk Adjustment Coding Specialist supporting risk adjustment efforts through chart reviews and provider education. Estimated travel up to 75% in Inland Empire region, specifically LA or Orange County.
About the role
- Medical Biller and Coder for family medicine practice ensuring accurate coding and claim submissions. Supporting revenue cycle management and maintaining compliance with billing regulations.
Responsibilities
- Accurately code diagnoses, procedures, and visit documentation using ICD-10, CPT, and HCPCS coding systems
- Review and audit daily charts to ensure complete, accurate, and compliant coding
- Prepare and submit insurance claims to payers in a timely and compliant manner
- Monitor and manage accounts receivable (A/R), including follow-ups on unpaid claims, rejections, and denials
- Investigate and resolve billing discrepancies with insurance providers
- Communicate effectively with the clinical team to clarify coding and documentation requirements
- Maintain comprehensive and confidential patient records in accordance with HIPAA guidelines
- Support revenue cycle processes to maximize reimbursements
Requirements
- Minimum 3–5 years of hands-on experience in medical billing and coding, specifically in family or internal medicine
- Strong knowledge of ICD-10, CPT, and HCPCS coding systems
- eClinicalWorks (eCW) experience is required — please specify when you last used it and in what capacity
- Familiarity with Trizetto (Gateway EDI) for claims submission and clearinghouse management
- Experience with Availity for eligibility verification, claim status, and ERA/EOB retrieval
- Comprehensive understanding of medical terminology and billing regulations
- High school diploma or equivalent required; Associate's degree preferred
Benefits
- 401(k)
- 401(k) matching
- Bonus based on performance
- Competitive salary
- Employee discounts
- Health insurance
- Paid time off
Job title
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Experience level
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