About This Role
This role is for an experienced FQHC Medical Coder/Biller with strong hands-on experience in Medicare and Medicaid coding, billing, and reimbursement. The position requires a solid understanding of FQHC billing requirements, Medicare/Medicaid guidelines, CMS regulations, and US healthcare coding standards. The candidate will be responsible for accurately reviewing documentation, assigning appropriate codes, processing and reviewing claims, and ensuring compliance with relevant requirements.
Responsibilities
- Perform accurate medical coding and billing for FQHC encounters, with a strong focus on Medicare and Medicaid claims
- Review clinical documentation and assign appropriate ICD-10-CM, CPT, HCPCS, and E/M codes
- Ensure claims are coded and billed accurately according to Medicare and Medicaid guidelines
- Apply FQHC-specific Medicare and Medicaid billing and reimbursement requirements
- Review claims for coding accuracy, eligibility, payer requirements, and potential billing discrepancies
- Identify and resolve coding and billing issues that may result in Medicare/Medicaid claim denials or payment delays
- Stay updated on changes to CMS, Medicare, Medicaid, CPT, ICD-10-CM, HCPCS, and FQHC regulations
- Ensure compliance with Medicare, Medicaid, CMS, HIPAA, payer guidelines, and organizational policies
- Understand and apply applicable Medicare and Medicaid reimbursement methodologies
- Support denial identification and resolution related to coding, documentation, and payer requirements
- Maintain required quality, accuracy, productivity, and turnaround time standards
- Collaborate with billing, AR, QA, and operations teams to resolve claim-related issues
Requirements
- 2-4 years of experience in US Healthcare Medical Coding/Billing
- Strong hands-on experience with Medicare and Medicaid medical coding and billing
- Good understanding of FQHC billing and reimbursement requirements
- Strong knowledge of ICD-10-CM, CPT, HCPCS, and E/M coding
- Good understanding of CMS Medicare and Medicaid guidelines
- Experience reviewing and correcting coding-related claim errors and denials
- Knowledge of Medicare/Medicaid payer requirements and reimbursement processes
- Strong knowledge of medical terminology and anatomy
- Good documentation review and analytical skills
- Strong attention to detail and ability to maintain coding accuracy
- Ability to meet quality and productivity targets
- Willingness to work from office in Bangalore
- Strong communication, analytical, and documentation review skills
Preferred Certifications:
