Job Details

Medical Records Coder II/III

San Mateo County Health is seeking an experienced Medical Records Coder II/III to join Correctional Health and support the coding of CalAIM billable services, including clinic visits and ancillary services. This position plays an important role in ensuring accurate reimbursement while supporting continuity of care for justice-involved individuals.

The successful candidate will perform billing functions related to the Department of Health Care Services (DHCS) Justice-Involved CalAIM Initiative. This initiative allows eligible incarcerated individuals to enroll in Medi-Cal prior to their release and enables reimbursement for covered healthcare services provided during the 90 days before reentry, helping support successful transitions back into the community.

This position requires independent proficiency in ICD-10 and CPT coding, coding audits, physician education on coding practices, Evaluation and Management (E/M) coding, and identifying and resolving billing edits.

This assignment primarily focuses on professional fee (profee) coding, with the majority of work involving outpatient clinic visits. Additional assignments may include other professional fee chart types. A strong understanding of ICD-10/CPT coding guidelines, code combinations, and documentation requirements is essential for success.

Initial training will be provided onsite in the Health Information Management Department in San Mateo. Following training, the successful candidate will primarily work in the adult correctional facilities in Redwood City and/or the Youth Services Center in San Mateo. Remote work options may be available based on operational needs.

Key Responsibilities

Depending on the level at which the candidate is hired, responsibilities may include:

• Independently review clinical documentation and assign accurate ICD-10-CM, CPT, HCPCS Level II, Evaluation and Management (E/M), and modifier information for outpatient professional-fee services while applying official coding guidelines, National Correct Coding Initiative (NCCI) edits, payer requirements, and County coding policies.
• Review coding work queues, claim edits, denials, and unresolved accounts; identify coding, documentation, workflow, or system issues; and take timely action to resolve billing discrepancies.
• Collaborate with providers and clinical staff to clarify documentation, provide coding education, and promote accurate, complete clinical documentation.
• Conduct prospective and retrospective coding audits, identify error trends, document findings, and recommend corrective actions.
• Monitor coding inventory, aging accounts, audit findings, productivity, accuracy, quality, and turnaround-time expectations.
• Maintain current knowledge of ICD-10-CM, CPT, HCPCS, E/M guidelines, Medi-Cal requirements, CalAIM policies, and other applicable regulations.
• Collaborate with Correctional Health, Health Information Management, Patient Financial Services, clinical departments, Epic support teams, and other County partners to improve coding procedures, documentation practices, educational resources, and standardized workflows.
• Maintain patient confidentiality and comply with all privacy, information security, and correctional facility requirements.
• Perform related duties as assigned.

Why Join Our Team?

This is an opportunity to help build and support an innovative program that expands access to reimbursable healthcare services for justice-involved individuals as they transition back into the community. In this role, you will collaborate with clinical, operational, and revenue cycle teams to improve documentation quality, coding accuracy, provider education, and billing workflows while helping ensure the long-term sustainability of Correctional Health services.

Success in this role requires adapting to evolving CalAIM, Medi-Cal, and coding requirements; resolving complex documentation and billing issues across multiple clinical disciplines; maintaining high standards of coding quality and productivity; and collaborating across departments within a correctional healthcare environment.

The ideal candidate will bring:

Technical Expertise

• Advanced knowledge of ICD-10-CM, CPT, HCPCS Level II, Evaluation and Management (E/M) coding, National Correct Coding Initiative (NCCI) edits, modifiers, and documentation requirements.
• Experience performing professional-fee and/or outpatient coding in a healthcare setting.
• Strong understanding of coding compliance, reimbursement methodologies, payer policies, and ethical coding standards.
• Experience conducting coding audits, identifying error trends, and implementing corrective actions.
• Proficiency using Epic or another electronic health record, coding encoder, abstracting, or claim-editing system.
• Experience using reports, dashboards, or other tools to monitor coding quality, productivity, inventory, and unresolved accounts.
• Ability to accurately interpret medical, behavioral health, substance use treatment, and care-management documentation.

Professional Skills

• Ability to work independently with minimal supervision while exercising sound judgment within established guidelines.
• Strong organizational skills with the ability to prioritize competing responsibilities and consistently meet deadlines.
• Excellent written and verbal communication skills, with the ability to build effective working relationships across multidisciplinary teams.
• Strong analytical, critical thinking, and problem-solving skills with exceptional attention to detail.
• Adaptability and a commitment to continuous learning in an evolving healthcare and regulatory environment.
• A collaborative, team-oriented approach while thriving in a fast-paced setting.

Preferred Qualifications

• Experience with Medi-Cal, Medicaid, Medicare, or another government healthcare payer.
• Experience with the CalAIM Justice-Involved Reentry Initiative or another complex public healthcare reimbursement program.
• Experience coding services in correctional health, community health, behavioral health, substance use treatment, or another integrated healthcare setting.
• Experience using Epic coding, charge review, claim edit, or revenue cycle work queues.

Important: Candidates for positions in Correctional Health must successfully complete an extensive security clearance conducted by the San Mateo County Sheriff's Office and undergo a thorough background investigation before a final offer of employment can be made.

Note: The eligible list generated from this recruitment may be used to fill future extra-help, term, unclassified, and regular classified vacancies.