Billing & Coding Specialist ll

Purpose: The purpose of the Billing and Coding Specialist II position is to ensure the accurate and timely processing of medical, dental, behavioral health, and ancillary service claims in compliance with Federally Qualified Health Center (FQHC) standards.

This role supports the financial sustainability of Connect Health + Wellness by maximizing reimbursement through correct coding practices, clean claim submission, and effective resolution of billing issues. The position also ensures alignment with HRSA, Medicare, Medicaid, and commercial payer requirements while upholding the organization's commitment to accessible, high-quality care for all patients.

Position Summary: The Billing and Coding Specialist II at Connect Health + Wellness is responsible for the accurate assignment of procedural codes, submission of clean claims, and resolution of billing discrepancies. This position ensures that all clinical services, including medical, behavioral health, dental, and ancillary services, are coded and billed in compliance with FQHC-specific requirements, including Medicare PPS, Medicaid Managed Care, commercial payer guidelines, and HRSA standards. The ideal candidate is detail-oriented, efficient, and committed to advancing our mission of providing quality, affordable care to patients within our service area.

Essential Functions of the Position

Medical Coding Responsibilities

• Assign accurate CPT, HCPCS, and ICD-10-CM codes based on provider documentation for all service lines (Medical, Dental, Behavioral Health, and Ancillary).
• Ensure appropriate use of modifiers and encounter-based billing codes (e.g., T1015, G-codes) in accordance with FQHC billing rules.
  • Review clinical documentation to confirm medical necessity and alignment with coded services.
  • Collaborate with providers to clarify unclear documentation and recommend improvements for coding compliance.
  • Keep current on payer updates, code set changes, and compliance policies through ongoing education.

Billing Responsibilities

• Prepare, review, and submit timely and accurate claims to Medicare, Medicaid, MCOs, and commercial payers.
• Ensure accurate application of the Sliding Fee Discount Schedule based on patient eligibility and income documentation. - Track and resolve denied, rejected, or underpaid claims by identifying root causes and correcting issues.
• Post insurance payments, contractual allowances, and patient payments accurately into the billing system.
• Monitor and follow up on outstanding accounts receivable to ensure timely reimbursement and minimize aging.

Cross-Functional Coordination

• Collaborate with front desk staff and financial counselors to ensure accurate demographic, insurance, and eligibility data is captured at registration.
• Assist with training staff on documentation requirements that affect billing and coding compliance.
• Support Uniform Data System (UDS) and cost reporting by ensuring all billable encounters are accurately coded and billed.

Compliance and Documentation

• Maintain strict confidentiality of all patients and organizational data in accordance with HIPAA.
• Adhere to Connect Health + Wellness’s policies and procedures as well as federal and state regulations governing FQHC operations.
• Participate in internal audits and implement feedback to improve accuracy and compliance.
• Perform any other duties as assigned by the supervisor that align with the mission and goals of the organization.

Pay Range: $20.00 to $27.00 per hour

Benefits:

• Paid Holidays (8)
• Paid Time Off (160 hours)
• Simple IRA Plan (with company match)
• Medical, Dental and Vision Insurance
• Life Insurance provided by employer
• Short-term and Long-term Disability coverage provided by employer
• Other voluntary plans available