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Providence Specialty Coder in Santa Monica, California


Providence is calling a Specialty Coder (Full-Time/Day ) to our Providence Saint Johns Medical Foundation in Santa Monica, CA.

We are seeking a Specialty Coder who will be under the direction of Saint John's Medical Foundation Coding Supervisor and Business Manager, performs coding audits of patient care billing documentation to ensure adherence with CPT and ICD coding guidelines and federal, state, and commercial payor billing and payment policy for all services provided by the Saint John's Medical Foundation.

In this position you will:

  • Revenue Capture:

  • Ensures all services provided are accurately captured in the medical record and billed appropriately. This is accomplished using the following methods:

  • Provide feedback to Coding Supervisor and Coding and Compliance Coding Team when deficiencies are identified.

  • In-depth understanding of charting tools (i.e. order entry, smart sets etc.), charge dropping, and charge update, Charge review work tickler systems.

  • Working all CCI/LMRP edits, claims manager rules and other coding associated charge review WQ rules for each clinic or department supported.

  • Maintain a current knowledge of regulations and legislation regarding billing compliance issues related to coding.

  • Denial Management:

  • Working all coding related denials.

  • Working all coding related patient complaints.

  • Ability to verify insurance coverage through multiple source tools (internet, telephone, RTE).

  • Coding Compliance/Integrity:

  • When provider documentation issues are identified, escalate to Coding Supervisor.

  • Work collaboratively with other coders on special projects and coding or reimbursement issues. Attend clinic and department staff meetings when invited to become familiar with operational issues within each business unit when necessary.

  • Demonstrate responsibility and accountability for own professional practice in regard to:

  • Attendance, punctuality and patient confidentiality.

  • Positive public relation image and working relationships.

  • Obtaining necessary knowledge and skill needed to maintain competence and certifications.

  • Completing all mandatory requirements, including annual safety programs, infection control and annual physical.

  • Comply with Foundation, department and unit standards, including but not limited to safety, infection control, quality management, environmental, confidentiality, and patient care.

  • Participate in the development and attainment of team, department and foundation goals including:

  • Attending and participating in department meetings.

  • Volunteering or accepting assignments for projects.

  • Mission, vision and team ground rules.


Required qualifications for this position include:

  • Bachelor's Degree -or- equivalent educ/experience

  • Experience with Microsoft Office (Word, Excel, Outlook)

  • Knowledge of third-party billing and payment requirements for third party payors including managed care benefits.

  • Knowledge with third-party medical insurance, diagnostic & procedural coding and medical billing.

  • Auditing of medical documentation to determine coding and billing adequacy.

  • Understanding of medical coding and billing compliance concepts.

  • Understanding of MPFS, NCCI, LCD, NCD, RVU, modifiers, and global periods.

  • Coding / Reviewing patient care documentation for billing purposes.

  • Knowledge of medical terminology and documentation requirements by California licensing and accrediting agencies.

  • Familiarity of interdepartmental interactions as it relates to Revenue Cycle.

  • Ability to run productivity reports and provide constructive feedback to team.

  • Understanding of Medical Group operations.

  • Knowledge of third-party billing and payment requirements for third party payors including managed care benefits.

  • Ability to communicate/interface effectively both verbally and in writing with physicians and employees at all levels of the organization.

  • Excellent customer service skills.

  • Must have initiative and use proper judgment with minimal supervision.

  • Must be detail-oriented, organized, and able to prioritize and manage multiple projects and meet deadlines.

  • Must be computer literate.

  • Familiarity or working knowledge with an electronic medical record environment.

  • Troubleshooting / analysis / problem solving / detail-oriented.

  • Certification as a Certified Coding Specialist – Physician (CCS-P), CPC, or CPC-A

Preferred qualifications for this position include:

  • Coding experience in HCC coding, Primary Care, Oncology, Infusion, Neurology, OB/GYN, Cardiology, Endocrinology, Rheumatology, General Surgery

  • Physician billing experience

  • 3 years Physician/clinic billing experience

  • Additional certifications (specialty coding certifications) strongly preferred

  • Medical billing and coding certificate

About the hospital you will serve:

Providence Saint John’s Health Center in Santa Monica, California, is part of Providence Health & Services, an integrated, not-for-profit network of hospitals, care centers, medical clinics, home health services, affiliated services and educational facilities in the western United States. Founded in 1942, Providence Saint John’s Health Center enjoys a reputation for clinical excellence across many disciplines.

The 266-bed health center has a medical staff of more than 900 physicians, 1,800 employees and a host of volunteers who share a commitment to providing quality care for all.

For information on our comprehensive range of benefits, visit:

Our Mission

As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Full-time

Shift: Day

Job Category: Coding

Location: California-Santa Monica

Req ID: 266253