Certified Coder

Description

Duties and Responsibilities

• 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.

• 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.

• Monitors billing performances to ensure optimal reimbursement while adhering to regulations prohibiting unbundling and other questionable practices; prepares periodic reports for clinical staff identifying unbilled charges due to inadequate documentation.

• Ability to research, analyze and disseminate Local Coverage Determination (LCD) as necessary reporting issues and potential solutions to manager

• Review all claims returned for Medical Necessity and correct if able; report findings to manager

• Monitors external data sources to ensure receipt and analysis of all charges.

• Ensures strict confidentiality of financial and medical records.

• 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.

• Performs related duties, such as answering phone inquiries, aiding providers as needed in the completion of their records.

• Assists in insurance billing and working denials as needed

• Maintains current CPC certification by fulfilling continuing educations hours as required.

• Performs miscellaneous job-related duties as assigned.

Qualifications

Minimum Job Requirements

• 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

Knowledge, Skills and Abilities Required

• 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

Working Conditions and Physical Effort

• 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.

Education & Experience

• High School Diploma or GED. Associates degree desirable.

• Two years of experience working in the health care field.

• EHR knowledge preferred

Other Requirements

• Occasionally means .25 to 2.5 hours per day
  

• Frequently equates to - 2.5 to 5.5 hours per day
  

• Continuously means >5.5 hours per day