Under the direct supervision of the Assistant Director of Revenue Cycle Management or Coding Supervisor, the Medical Group Coder will improve documentation, data quality and revenue cycle operations. The coder reviews and analyzes medical records to accurately select all forms of HCPCS service codes (HCPCS, CPT, CPTII, CPTIII) and ICD-10-CM codes for professional services of hospital-based surgical specialty providers. This includes services in the office or other outpatient settings and inpatient settings.

Core Job Responsibilities

Assign the applicable HCPCS (HCPCS, CPT, CPTII, CPTIII) service codes based on review and analysis of medical records, following CMS, CPT, insurance company, hospital based and office based guidelines.
Assign applicable modifiers, review medical necessity, CCI and other internal and external coding edits.
Assign applicable ICD-10-CM diagnosis codes based on knowledge of ICD-10-CM, insurance company, hospital based and office based guidelines.
Submit queries to providers, clinical staff and managers regarding incomplete, unclear, or inconsistent documentation. Re-submit queries as necessary to ensure timely resolution.
Provide education to providers and clinical staff regarding documentation and work flow opportunities.
Assist departments with diagnostic and procedural coding.
Assist Business Office with insurance denials.
Perform other duties as required.

Education/Experience Requirements

REQUIRED:

Minimum of two years surgical based coding experience or specialty based professional credential
Knowledge of EMR, electronic coding resources, Microsoft Office and email systems

PREFERRED:

Completion of specialty based coding coursework or equivalent
Knowledge of Epic, 3M ICD-10-CM and CPT software, Vitalware, Microsoft Office, Email systems
Knowledge of CMS Teaching Physician Guidelines for Residents and Medical Students
2 years of hospital based, specialty based professional coding experience, or equivalent

Licensure/Certification Requirements

REQUIRED:

CPC, CCS-P, or related AHIMA or AAPC professional specialty certification

PREFERRED:

CPC, CCS-P, or specialty based professional credential

Disclaimer

Qualified applicants will receive consideration for employment without regard to their age, race, religion, national origin, ethnicity, age, gender (including pregnancy, childbirth, et al), sexual orientation, gender identity or expression, protected veteran status, or disability.
Successful candidates might be required to undergo a background verification with an external vendor.

Job Details

Req Id 95141
Department MEDICAL GROUP ADMINISTRATION
Shift Days
Shift Hours Worked 8.50
FTE 1
Work Schedule HRLY NON-UNION-8 HR
Employee Status A1 - Full-Time
Union Non-Union
Pay Range $23.20 - $35.60 Per Hour

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