The medical coder provides quality assurance of front-end activities of physician billing for primary care, specialists and ancillary services including coding and billing capture. S/he is responsible for inputting the appropriate code of various medical services so that healthcare practitioners and providers can receive payment for services rendered. S/he assigns and identifies the information by using the accurate ICD-10-CM and CPT codes. S/he is responsible for making sure the assigned codes meet all federal, legal and insurance regulations so service payments are obtained in a timely fashion. S/he responds to coding inquiries as needed. S/he provides post-submission reviews to assist in denial management and timely resubmission of corrected claims or appeals in conjunction with the Reimbursement Resource Representatives.
Essential Duties and Responsibilitiesinclude the following. Other duties may be assigned.
- No coding errors
- Understands ICD-10-CM and CPT codes
- Verifies DX and treatment entries are complete and accurate
- Queries physicians or support staff when codes are incorrect
- Knows all changes in coding guidelines
- Uses auditing tools to monitor accuracy
- Provides weekly summary to Coding/Quality MGR of annual code updates, trends, concerns, carrier updates to ensure timely responses and actions.
- Identifies trends that require action
- Maintains active professional certification and complies with all educational, professional and ethical requirements of said certification
QualificationsTo perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience
Associate's degree or equivalent from two-year college or technical school.1 years clinical and/or Medicare Risk Adjustment experience.1 years of quality improvement experience, or other relevant experience preferred.
Experience working in health care and insurance industry.
Knowledge base of clinical standards of care, preventive health standards and Medicare Risk Coding.
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
To perform this job successfully, an individual should have proficient knowledge of Microsoft Excel Spreadsheet software; Microsoft Word Processing software, Outlook and ADP Payroll systems. Knowledge of Computers, Fax, Portals, Uploading, Downloading, Athena or other Electronic Medical Record System.
Certificates, Licenses, Registrations
Certified Coder; CPC, CCS-P, CCS-H, RHIT
Physical DemandsThe physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; climb or balance and talk or hear. The employee is frequently required to stand and walk. The employee is occasionally required to stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
Work EnvironmentThe work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.The noise level in the work environment is usually moderate depending on business activity of the office.0