Medical Coder, Denial Coder, Medical Coding Specialist

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Evaluates medical record documentation and charge-ticket coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflects and supports visits and to ensure that data complies with legal standards and guidelines.
• Interprets medical information such as diseases or symptoms and diagnostic descriptions and procedures to accurately assign and sequence the correct ICD-10-CM and CPT codes.
• Reviews state and federal Medicare reimbursement claims for completeness and accuracy before submission to minimize claim denial.
• Evaluates records and prepares reports on such topics as the number of denied claims or documentation or coding issues for review by management and/or professional evaluation committees.
• Makes recommendations for changes in policies and procedures to maintain standards for correct coding, to minimize the risk of fraud and abuse, and to optimize revenue recovery.
• Provides technical guidance to physicians and other staff in identifying and resolving issues or errors such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, and/or codes that do not conform to approved coding principles/guidelines.
• Reads bulletins, newsletters, and periodicals and attends workshops to stay abreast of issues, trends, and changes in laws and regulations governing medical record coding and documentation.
• Educates and advises staff on proper code selection, documentation, procedures, and requirements.
• Performs other duties as assigned.

MINIMUM JOB REQUIREMENTS

Education, Training, and Experience Required:

• Bachelors Degree or 3 year Diploma or equivalent is required.
• Possession of a current Certified Professional Coder (CPC) issued by the American Academy of Professional Coders preferred.
• Two (2) years of medical coding experience is required, or the;
• Equivalent combination of experience, education, and training that would provide the required knowledge and abilities.

Knowledge/Skills/Abilities:

• Knowledge of ICD-10-CM and CPT coding guidelines; medical terminology; anatomy and physiology; state and federal Medicare reimbursement guidelines; English grammar and usage.
• Ability to research and analyze data, draw conclusions, and resolve issues; read, interpret, and apply policies, procedures, laws, and regulations.
• Ability to read and interpret medical procedures and terminology.
• Ability to develop training materials, make group presentations, and to train staff
• Ability to exercise independent judgment;
• Excellent written and verbal communication skills to prepare reports and related documents and to maintain working relationships with physicians and other staff.
• Ability to competently use Microsoft Office Suite, particularly Word, Excel and Outlook.
• Ability to maintain confidentiality.
  

Perks and Benefits

As per market standards