Billing & Coding Specialist

Reports to: Chief Financial Officer

Organization: The Health Care Connection (THCC)

Location: Cincinnati, OH - Lincoln Heights - ON-SITE POSITION

About The Health Care Connection:

Founded in 1967, The Health Care Connection was Ohio’s first Federally Qualified Health Center (FQHC). Our mission is to provide quality, culturally sensitive and accessible primary healthcare services. THCC is proudly recognized as a Level 3 Patient Centered Medical Home (PCMH), the highest level of recognition attainable for quality care.

We boast two primary care locations and 6 school-based health centers providing quality value-based care for over 20,000 patients. We provide services in Primary Care, Infectious Disease, Substance Use, Integrated Behavioral Health, Dental Services, Women’s Health, and Pharmacy.

• Health Insurance and Rewards Program
• Dental, and Vision Insurance
• Free Life & Short-Term Disability Insurance
• 403(b) Retirement Plan with employer match
• 10 Paid Holidays

The Billing & Coding Specialist is responsible for accurate coding, charge review, risk‑adjustment support, and claims coordination within an FQHC environment. This role facilitates communication and workflows with the third‑party billing company, ensures compliance with FQHC billing requirements, supports providers with documentation improvement, and participates in revenue cycle special projects.

• Perform coding review of encounters to ensure accurate CPT, HCPCS, and ICD‑10 coding in compliance with payer and FQHC rules.
• Ensure accurate capture of risk‑adjusting diagnoses (HCC) and communicate documentation needs to providers.
• Conduct ongoing coding audits and maintain documentation of findings, trends, and corrective action steps.
• Collaborate with the third‑party billing company to resolve coding‑related denials, edits, and claim rejections.
• Assist in monitoring A/R trends, denial rates, and vendor performance metrics.
• Review charge data for completeness, accuracy, and compliance prior to submission.
• Support month‑end close activities including coding reconciliation and reporting.
• Participate in special projects such as workflow redesign, EHR template optimization, payer audits, and regulatory updates.
• Provide coding and documentation guidance to providers and clinical departments.
• Develop and host coding and documentation training sessions for providers and clinical staff to improve coding accuracy, documentation quality, risk‑adjustment capture, and compliance.
• Ensure adherence to HRSA, UDS, Medicaid/Medicare, HIPAA, and other regulatory requirements.

• High school diploma required; associate degree in health information, billing, or related field preferred.
• Experience or training in risk‑adjustment coding; CRC preferred or willingness to obtain within 12 months.
• Minimum 2 years of medical billing and coding experience; FQHC experience strongly preferred.
• Knowledge of CPT, HCPCS, ICD‑10, PPS/GFQHC billing rules, Medicaid, Medicare, and commercial payer requirements.
• Strong communication skills, attention to detail, and ability to collaborate with clinical, administrative, and external teams.
• Proficiency with EHR and billing software systems.

• Experience coordinating with external billing vendors.
• Experience with Next Gen and EPIC.
• Risk‑adjustment coding certification (CRC).

The Health Care Connection is focused on creating a community that promotes dignity and respect for employees, patients and other community members. THCC is an Equal Opportunity Employer and a Drug‑Free Workplace. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, military status or other characteristics protected by law and will not be discriminated against based on disability.

THCC will only employ those who are legally authorized to work in the United States. Any offer of employment is conditioned upon the successful completion of a background check and a drug screen.