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The Medical Coder complies with all legal requirements regarding coding procedures and practices. Conducts audits and coding reviews to ensure all documentation is accurate and precise, assign and sequence all codes for services rendered and collaborate with the business office to ensure all bill are satisfied in a timely manner. This position will also communicate with insurance companies about coding issues, submit statistical data for analysis and research by other departments and contact physicians and other health care professionals with questions concerning coding.

Essential Duties:

+ Utilize specialized medical classification software to assign procedure and diagnosis codes for insurance billing.

+ Review claims data to ensure that assigned codes meet required legal and insurance rules and that required signatures and authorizations are in place prior to submission.

+ Conduct medical records research and correspond with insurance companies and healthcare professionals to resolve issues resulting from denied claims.

+ Adhere to coding policies and procedures consistent with the industry standard guidelines for CPT, ICD-9 and ICD-10.

+ Answer coding questions

+ Review clinical documentation to ensure it meets level of CPT codes and ICD-10 codes

+ Performs related duties, as requested.

+ Upholds the Organization's ethics and customer service standards.

This job description is not intended to be all-inclusive. Employee may perform other related duties to meet the ongoing needs of the hospital. Duties may be modified or changed with or without notice.

Requirements

Education and/or Licensure – High School degree required. Certificate or associate's degree in medical coding/CPC. These additional certifications are not required but a plus: Certified Professional Coder (CPC), CPC-Hospital, CPC-Payer, Certified Interventional Radiology Cardiovascular Coder (CIRCC) and Certified Professional Medical Auditor (CPMA)

Experience – A minimum of one (1) year coding experience required, preferably with psychiatric services.

Additional Requirements – Bi-lingual English/Spanish preferred but not required.

Knowledge Skills and Abilities

+ Knowledge of medical terminology; basic and advanced ICD-9-CM coding; anatomy and physiology; computer data entry; and medical law, privacy and ethics.

+ Knowledge of CMS rules and regulations and current coding resources

+ Knowledge of Healthcare Common Procedure Coding Systems (HCPCS), Current Procedural Terminology (CPT) coding and healthcare reimbursement methods.

+ Critical thinking skills and ability to resolve complex coding issues

+ Knowledge of mathematical computations using addition, subtraction, multiplication, division, percentages in order to perform personnel/payroll assignment. Ability to integrate multiple facts, statistics, and/or mathematical values when solving mathematical equations.

+ Ability to accurately enter data, prepare and maintain records, files, and reports.

+ Outstanding skills in giving attention to details with display of dexterity in maintaining confidentiality

+ Must have advanced PC skills that include a combination of working in a Windows Operating System and Microsoft Outlook, Word and Excel as well as ability to use financial software and payroll systems (Kronos a plus).

+ Communicate effectively with a variety of individuals and function calmly in situations, which require a high degree of sensitivity, tact, and diplomacy.

+ Ability to exercise appropriate judgment in answering questions and releasing information; analyze and project consequences of decisions and/or recommendations.

+ Skill to research and analyze various personnel/payroll matters to recommend alternative actions and/or take an appropriate course of action.

+ Skill to independently interpret reference materials to comply with law, rules, regulations, policies, procedures, etc.

+ Ability to apply time management practices to prioritize, schedule and complete work effectively to comply with mandated policies and deadlines.

+ Ability to work on multiple tasks or parts of tasks simultaneously to ensure timely completion of work activities.

Physical Requirements/Environmental Conditions

Perform the following with or without reasonable accommodations:

+ Ability to stoop, kneel, crouch, crawl, reach, stand, walk, push, pull, lift, grasp, and be able to perceive the attributes of objects such as size, shape, temperature, and/or texture by touching with skin, particularly that of the fingertips.

+ Ability to express and exchange ideas via spoken word during activities in which they must convey detail or important spoken instructions to others accurately, sometimes quickly and loudly.

+ Hearing to perceive the nature of sound with no less than 40 db loss @ Hz, 1000 Hz, and 2000 Hz with or without correction; ability to perceive detailed information orally and make fine discriminations in sound.

+ Perform repetitive motions with wrists, hands, and fingers. Individual must be able to exert up to 100 pounds of force occasionally and to be able to lift, carry, push, pull, or otherwise move objects.

+ Work requires a minimum standard of visual acuity with or without correction that will enable people in the role to complete administrative and clerical tasks, as well as inspect and analyze.

+ Must be able to work and concentrate amidst distractions such as noise, conversation and foot traffic; ability to handle interruptions often and be able to move from one task to another

+ While worker may possibly be subjected to temperature changes, the worker is generally not substantially exposed to adverse environmental conditions as the work is predominantly inside.

Benefits

+ Health Insurance

+ Vision Insurance

+ Dental Insurance

+ 401K Retirement Plan

+ Healthcare Spending Account

+ Dependent Care Spending Account

+ PTO Plan with Holiday Premium Pay

+ Life Insurance (Supplemental Life, Term, and Universal plans are also available.)

+ Short and Long-Term Disability (with additional buy-in opportunities)