Position Summary
The Certified Medical Coder and Biller is responsible for accurate medical coding, charge capture, and timely billing of services provided within a Federally Qualified Health Center (FQHC). This role ensures compliance with federal, state, and payer-specific regulations, including HRSA, CMS, Medicare, Medicaid, and managed care requirements. The position plays a key role in maintaining revenue integrity while supporting the organization’s mission to provide high-quality, affordable care to underserved populations.
Responsibilities and Duties
- Coding Responsibilities
- Assign accurate CPT, HCPCS, and ICD-10-CM codes in accordance with official coding guidelines and FQHC requirements
- Review clinical documentation to ensure coding accuracy, completeness, and medical necessity
- Apply appropriate modifiers, revenue codes, and PPS/encounter billing methodologies (e.g., T1015 where applicable)
- Identify documentation deficiencies and collaborate with providers to obtain clarification
- Support internal and external audits by providing coding documentation and rationale
- Stay current on coding updates, regulatory changes, and FQHC-specific guidance
Billing Responsibilities
- Prepare, review, and submit clean claims to Medicare, Medicaid, commercial insurers, and other third-party payers
- Verify patient eligibility, insurance coverage, and benefits prior to billing
- Review charges for accuracy and compliance before claim submission
- Monitor claim status and follow up on unpaid, denied, or rejected claims
- Correct, resubmit, and appeal claims as appropriate
- Post payments, adjustments, and denials accurately in the practice management system
- Work accounts receivable aging reports to support revenue cycle performance goals
- Respond to payer inquiries, audits, and requests for medical records
- Ensure compliance with HRSA, CMS, state Medicaid, and payer-specific billing requirements
General Responsibilities
- Maintain patient confidentiality and comply with HIPAA regulations
- Collaborate with clinical, front desk, coding, and finance teams to resolve revenue cycle issues
- Assist with process improvement initiatives related to coding accuracy and billing efficiency
- Participate in ongoing education related to FQHC billing and coding updates
Qualifications
Knowledge, Skills and Abilities
- Strong analytical and problem-solving skills
- Ability to manage multiple priorities and meet deadlines
- Effective written and verbal communication skills
- Ability to work independently and collaboratively
- Commitment to the mission and values of community-based healthcare
Education
- Certified Professional Coder (CPC) certification required
- High school diploma or GED required, associate degree in health information management, healthcare administration, or related field preferred
- Minimum of 2–3 years of combined medical coding and billing experience
- Experience in an FQHC, community health center, or similar safety-net setting preferred
- Strong knowledge of Medicare, Medicaid, and managed care coding and billing processes
- Working knowledge of FQHC PPS/encounter billing and sliding fee scale concepts
- Proficiency with EHR and practice management systems
- Strong attention to detail and organizational skills
Experience
- Minimum of 2 years of experience in billing
- Experience with ICD-10, CPT, and HCPCS coding required
- Prior experience with Medicare, Medicaid, and commercial insurance billing strongly preferred
- Experience in an FQHC or community health center environment preferred
Work Environment and Physical Demands
- This position is full-time and requires onsite presence during regular business hours
- Primarily sedentary office work with extended periods of computer use
- Occasional interaction with clinical and administrative staff
Disclaimer
The above is intended to describe the job functions, the general supplemental functions and the essential requirements for the performance of this job. It is not to be construed as an exhaustive statement of supplemental duties, responsibilities, or non-essential requirements.
Medical Associates Plus is an Equal Opportunity Employer and does not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identity and/or expression, veteran status, basis of disability or any other federal, state or local protected class.