Certified Medical Coder

Job Title: Certified Medical Coder

Reports To: Director, Revenue Cycle

Job Summary: Reviews and ensures accuracy of medical coding for all services rendered by assigned providers including appropriate diagnostic documentation of risk and chronic conditions through a master understanding of specific ICD -10 codes and CPT II codes.

Qualifications and Requirements:

The requirements listed below are representative of the knowledge, skill, and/or ability required. Job duties may be modified at any time based on business needs.

Essential Job Duties:

• Assigns and sequences appropriate diagnostic/procedure billing codes, in compliance with third party payer requirements.
• Acts as a coding claims review specialist.

• Provides appropriate training and education to staff on current and future coding guidelines based on industry trends and best practices.
• Researches and completes coding projects as assigned.
• Reviews and modifies, if necessary, CPT, HCPCS and ICD-10 codes from assigned provider visit notes in a timely fashion, ensuring all supported codes are captured on the claim form(s) and submits to the health plan; closing both HCC and HEDIS/Stars care gaps.
• Establishes themselves as the expert in CPT II and ICD-10 coding, and the relationship between specific coding practices and medical risk stratification.
• Queries the provider for clarification, as needed using communication guidelines provided by the RCD/Physician Coder.
• Identifies providers who may need additional educational training about their documentation and/or code selection.
• Coding quality is at 95% accuracy or greater.
• Collaborates with RCD/Physician Coder regarding planned provider coding education sessions.
• Participates regularly required in CCHCI training, personal performance, and staff meetings.
• Assists in addressing unbilled/unsubmitted encounters.

Required Minimum Qualifications - Education, Experience, Certificates & Licenses:

• High School Diploma or GED.
• Current professional coding certification required through AAPC or AHIMA.
• Documented Participation in training and education programs to maintain professional competence and skills applies.

Preferred Qualifications - Education, Experience, Certifications & Licenses:

• One year's experience in medical billing preferred.

Required Language Skills:

• Ability to comprehend and compose effective instructions, correspondence, and communications in English in both oral and written format.

Physical Requirements:

• Ability to occasionally exert enough force to move objects weighing up to 10 pounds.
• Ability to continuously remain in a stationary position.
• Ability to occasionally move about inside the workplace to access files, office machinery, etc.
• Possesses hand-eye coordination and manual dexterity necessary to constantly operate computers, telephone, and other office machinery.
• Possesses close visual acuity necessary to accurately record and view information on a computer monitor, handwritten and typed documents.
• Ability to discern the nature of sounds at a normal spoken volume.

Other Required Knowledge, Skills, and Abilities:

• Ability to add, subtract, multiply and divide in all measure, using whole numbers, common fractions and decimals.
• Ability to compute rate, ratio and percentage.
• Ability to skillfully gather and analyze data.
• Ability to perform a variety of assignments requiring independent judgment.
• Ability to deal with challenges involving one or more variables in routine situations.
• Knowledge of billing, medical records, health plans, and community health centers preferred.
• Advanced, specialized knowledge of medical codes and coding procedures.
• Thorough knowledge of ICD, CPT, and NDC codes.
• Knowledge of HIPAA and Corporate Compliance rules and regulations.
• Computer literacy required with proficiency in Microsoft Excel.
• Knowledge of Electronic Health Records and Practice Management software preferred.

Work Environment & Conditions:

• Work environment is usually typical of an administrative office setting with no substantial exposure to adverse environmental conditions.
• Work may be regularly performed remotely as assigned and may include extended hours including early mornings, evenings, and weekends.