Certified Coder

Description

Summary of Position:

Under general supervision, but according to established procedures, codes, and abstracts patient’s records, in order to meet billing and data collection needs of the organization.

Essential duties:

Duties include, but are not limited to:

• Verify patient insurance coverage and eligibility.
• Accurately enter patient information, insurance details, and billing codes into the system.
• Analyzes and interprets patient medical records to identify and determine amount and nature of billable services; assigns and sequences appropriate diagnostic/procedure billing codes in compliance with requirements of third-party payor requirements.
• Interacts with providers regarding billing and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific documentation.
• Analyze coded data to identify trends, patterns, and potential areas of improvement.
• Performs periodic chart audits and prepares clear, concise education to providers.
• Act as an education resource for billing team, medical staff, and providers by answering questions pertaining to coding; and provide coding training to billing team and providers on an “as needed” basis.
• Ability to research, analyze and disseminate Local Coverage Determination (LCD) as necessary reporting issues and potential solutions to Team Lead.
• Stay informed about and adhere to healthcare regulations. Including HIPAA privacy rules.
• Review all claims returned for Medical Necessity and correct if able; report findings to Team Lead.
• Follows established departmental policies, procedures, and objectives, continuous quality improvement objectives, and safety and environmental standards.
• Attends coding conferences, workshops, and in-house sessions to receive updated coding information and changes in coding and/or regulations.
• Maintains current CPC certification by fulfilling continuing educations hours as required.
• Performs other duties as required.
• Other Duties as presented by supervisor and/or Directors.

Qualifications

Qualifications:

Basic Knowledge and Skills:

• Must be (at least) 21 years old.
• High School Diploma or GED Required.  Associate degree is desirable.
• Two years of experience working in the health care field.
• EHR knowledge preferred.
• Current Certification as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS).
• Three or more years of outpatient coding experience.
• ICD 10-CM knowledge.
• Medical coding and billing.
• Clinical workflow knowledge.
• Knowledge of auditing concepts and principles.
• Knowledge of legal and policy constraints pertaining to patient billing.
• Knowledge of medical terminology.
• Ability to analyze complex medical records and identify billable services.
• Ability to maintain quality and safety standards.
• Ability to use independent judgment and to manage and impart confidential information.
• Ability to analyze and solve problems.
• Knowledge of current and developing issues and trends in medical coding procedures requirements.
• Ability to clearly communicate medical information to professional practitioners.
• Ability to communicate technical information to non-technical personnel.
• Knowledge of ICD-10 and/or CPT medical billing codes.
• Knowledge of Microsoft Office products.
• EHR knowledge required.

Physical and Mental Requirements:

• Handle high levels of stress.
• Sit frequently.
• Walk frequently.
• Drive occasionally.
• Bend or stoop frequently.
• Use hands to push or pull occasionally.
• Fine manipulation continually. 
• No or very limited exposure to physical risk.
• No or very limited physical effort required.
• Work is normally performed in a typical interior/office work environment.

We are an equal-opportunity employer. All resumes will be reviewed for education and experience. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status, or any other legally protected status.