Billing and Coding Coordinator (Onsite / Hybrid)

About the role

Upstate Family Health Center is seeking a Billing and Coding Coordinator to join our dynamic team. This role is eligible for a remote or hybrid schedule, requiring on-site presence for meetings, trainings, or operational needs.

Responsibilities

• Billing and Charge Capture
• Review daily encounters for completeness, accuracy, and proper coding prior to claim submission.
• Ensure provider documentation supports billed services and meets FQHC requirements.
• Verify correct application of PPS rates, wrap-around billing rules, and sliding fee adjustments.
• Coordinate with clinical staff to resolve missing documentation, coding discrepancies, or encounter errors.
• Claims Submission & Processing
• Prepare, scrub, and submit electronic and paper claims to Medicaid, Medicare, commercial payers, and managed care plans.
• Maintain payer enrollment and billing credentialing information as needed.
• Monitor clearinghouse rejections and correct/resubmit claims promptly.
• Accounts Receivable Management
• Conduct timely follow-up on outstanding claims, denials, and underpayments.
• Document all follow-up actions in the billing system and maintain accurate A/R aging reports.
• Identify trends in denials or payment delays and escalate systemic issues.
• Process patient statements, payment plans, and refunds in accordance with clinic policy.
• Revenue Cycle Coordination
• Maintain workflows for registration accuracy, insurance verification, and point-of-service collections.
• Collaborate with front desk and clinical teams to reduce errors that impact reimbursement.
• Support month-end close processes, including reconciliation of encounters, adjustments, and payment posting.
• Participate in internal audits to ensure compliance with HRSA, Medicaid, Medicare, and NYS billing regulations.
• Compliance and Reporting
• Maintain strict confidentiality of patient information in accordance with HIPAA and clinic policies.
• Ensure billing practices align with FQHC requirements, payer contracts, and federal/state regulations.
• Prepare routine and ad-hoc reports on billing performance, A/R aging, denials, and productivity metrics.
• Support preparation for HRSA Operational Site Visits (OSVs) and payer audits.

Requirements

• Associate's degree at a minimum required
• Minimum 2 years of medical billing, accounts receivable, or revenue cycle experience in a NY State FQHC
• Certified Professional Coder
• ECW experience preferred, strong knowledge of Medicaid, Medicare, and commercial payer billing rules
• Experience with CPT/HCPCS coding, ICD10, and encounter documentation requirements
• Proficient with Microsoft Office Suite and comfortable with other billing and data systems
• Strong analytical, organizational, and follow-up skills
• Ability to handle confidential information with discretion
• Ability to work independently and manage multiple priorities

Skills

• Accuracy and attention to detail
• Problem-solving and persistence
• Effective communication with clinical and administrative staff
• Understanding of patient-centered, mission-driven care
• Ability to manage competing priorities in a fast-paced clinic environment

Benefits

We offer a comprehensive total compensation package including competitive compensation, a generous paid time off package, a benefits package including medical, dental, vision, FSA, HRA, Life Insurance, 403(B) with a lucrative company match, generous paid time off.