Medical Billing and Coding

• Coordinate/review the work of subordinate employees and assist with the training and continuing education programs.
• Code medical records utilizing ICD-10-CM and CPT-4 coding conventions.
• Review the medical record to ensure specificity of diagnoses, procedures, and appropriate/optimal reimbursement for hospital and/or professional charges.
• Abstract information from medical records following established methods and procedures.
• Review the complex (problematic coding that needs research and reference checking) medical records and accurately code the primary/secondary diagnoses and procedures using ICD-10-CM and/or CPT coding conventions.
• Ensure quality and quantity of work performed through regular audits.
• Assist with research, development, and presentation of continuing education programs in areas of specialization.
• Sequence the diagnoses and procedures using coding guidelines.
• Ensure DRG/APC assignment is accurate.
• Abstract and compile data from medical records for appropriate optimal reimbursement for hospital and/or professional charges.
• Consult with and educate physicians on coding practices and conventions in order to provide detailed coding information.
• Communicate with nursing and ancillary services personnel for needed documentation for accurate coding.
• Maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes, and surgical techniques through participation in continuing education programs to effectively apply ICD-10-CM and CPT-4 coding guidelines to inpatient and outpatient diagnoses and procedures.
• Maintain a thorough understanding of medical record practices, standards, regulations, Joint Commission on Accreditation of Health Organizations (JCAHO), Health Care/Finance Administration (HCFA), Medical Review of North Carolina (MRNC), etc.
• Assist with special projects as required.
• Perform other related duties incidental to the work described herein.

Medical Records Coder II – Ophthalmology

• Responsible for reviewing and accurately coding all professional services including evaluation and management, diagnostics, surgeries, and procedures in compliance with applicable Medicare, Medicaid, and third-party payer guidelines to ensure receipt of accurate reimbursement
• Expected to adhere to MedKoder’s internal coding policies and expectations set forth by department management
• Must prioritize daily duties, multitask, communicate effectively, and make the decisions necessary to complete all assigned tasks and accomplish their goals
• Review and accurately code profee Plastic Surgery cases to maximize reimbursement in a timely manner
• Review and accurately code E/M visits, office procedures, and surgeries
• Able to work independently and research coding scenarios
• Responsible for meeting our daily production goal and our quality goal of consistently averaging a 95% accuracy rate
• Attend conference calls as necessary to provide information and feedback
• Communicate with leadership on coding or documentation issues/trends
• Stay current on all coding guidelines (including specialty-specific guidelines) and maintain credentials as necessary
• Participate in coding department and education meetings
• Flexible to expand coding skill set into other Plastic Surgery subspecialties, or other specialties altogether
• Maintain confidentiality and protect sensitive information
• Other duties as assigned by leadership

Physician Coder – Plastic Surgery

• Review patient medical records to identify services performed and ensure accurate coding
• Assign appropriate ICD-10 codes and ensure charges are documented correctly
• Prepare and complete superbill documentation and forward to the billing department
• Support accurate medical billing by verifying documentation, signatures, and service details
• Collaborate with physicians, nurses, and administrative staff to ensure proper coding practices and compliance
• Ensure accurate and complete coding to support proper billing and reimbursement
• Identify missing or insufficient documentation and communicate with providers for clarification
• Assist in maintaining compliance with healthcare regulations and coding standards
• Support the billing and pre-certification teams by providing correct coding information
• Help improve workflow efficiency by reviewing unbilled reports and submitting charges promptly
• Contribute to quality patient care by ensuring medical records are complete and properly documented
• Collaborate with the clinical data and correspondence teams to track referrals and collect patient information

Software Developer

• Evaluates medical records, provides clinical and surgical abstraction and assigns appropriate clinical diagnosis and procedure codes.
• Analyzes medical information from medical records
• Accurately codes diagnostic and procedural information in accordance with national coding guidelines
• Consults with medical providers to clarify missing or inadequate record information and to determine appropriate codes.
• Provides thorough, timely and accurate coding in accordance to department specific productivity and quality standards.

Profee Coder – Primary Care

• Reviewing and accurately coding all professional services including evaluation and management, diagnostics, surgeries, and procedures in compliance with applicable Medicare, Medicaid, and third-party payer guidelines to ensure receipt of accurate reimbursement.
• Adhere to MedKoder’s internal coding policies and expectations set forth by department management.
• Prioritize daily duties, multitask, communicate effectively, and make the decisions necessary to complete all assigned tasks and accomplish their goals.
• Review and accurately code Cardiology IR/CV Surgery and E/M cases to maximize reimbursement in a timely manner.
• Review and accurately code E/M visits and office procedures.
• Able to work independently and research coding scenarios.
• Responsible for meeting daily production and quality goals of consistently averaging a 95% accuracy rate.
• Attend conference calls as necessary to provide information and feedback.
• Communicate with leadership on coding or documentation issues/trends.
• Stay current on all coding guidelines (including specialty-specific guidelines) and maintain credentials as necessary.
• Participate in coding department and education meetings.
• Flexible to expand coding skill set into other specialties.
• Maintain confidentiality and protect sensitive information.
• Other duties as assigned by leadership.

Physician Coder – Cardiology

• Assign accurate ICD-10-CM diagnosis codes and CPT/HCPCS procedure codes for ambulatory encounters in accordance with official coding guidelines, AMA CPT guidance, and payer-specific policy
• Apply correct modifiers (including 25, 26, 27, 50, 59, XE/XP/XS/XU, LT/RT, and global period modifiers) to support accurate reimbursement and pass NCCI and global edits
• Code across ambulatory settings including clinic E&M, ambulatory surgery, observation, emergency department, infusion/injection, diagnostic imaging, and ancillary services are assigned
• Review clinical documentation to confirm medical necessity and support code selection; submit compliant, non-leading physician queries when documentation is unclear, incomplete, or contradictory
• Apply correct sequencing of primary and secondary diagnoses and link diagnoses appropriately to procedures
• Identify and report charge capture errors, missing charges, and documentation deficiencies to the appropriate upstream owner
• Maintain coding accuracy at or above the client-defined threshold (typically 95%) and meet daily productivity targets (charts or encounters per hour, or RVU-based as defined by client)
• Document coding rationale and query activity clearly in the encoder, EHR, or coding workflow tool
• Resolve coding-related claim rejections and denials by reviewing payer responses, applying corrected codes or modifiers, providing supporting documentation, and following claims through to resolution
• Maintain current working knowledge of best coding practices, payer policy, and regulatory changes by accessing NCD, LCD, and coding policy resources and participating in continuing education
• Stay current with annual ICD-10-CM, CPT, and HCPCS code set updates, and MPFS final rules, and payer policy changes
• Maintain full compliance with HIPAA, CMS regulations, and fraud/abuse regulations including the False Claims Act
• Assignments may shift across ambulatory specialty areas based on client needs and individual strengths within the scope of the role

Coding Specialist

• Performs HCC coding on projects for MA, ACA, and End Stage Renal Disease (ESRD)
• Works independently in various coding applications
• Adheres to CMS Guidelines for Coding and Highmark’s Policy and Procedures
• Maintains RPM coding accuracy and productivity requirements
• Assists with Regulatory Audits by performing first coding review

HCC Coding Specialist

• Review and accurately code most professional services
• Conform with Medicare, Medicaid, and third-party payer guidelines
• Assign ICD-10, CPT, and/or HCPCS codes
• Review medical documentation for data integrity
• Communicate with providers for clarification or additional documentation

Coder Specialist

• Accurately assigns ICD-10, CPT and/or HCPCS codes as applicable and within established coding guidelines, rules, and regulations
• Types of Coding may include Professional medical coding, Surgical coding, and/or reviewing evaluation and management codes
• Inpatient coding of Diagnoses and PCS procedures for concurrent accounts and discharged accounts
• Ensures data integrity of coded patient records by reviewing medical documentation
• Acts as a resource by researching patient accounts in response to questions and/or errors
• Collaborate with assigned areas to identify query opportunities for documentation improvement
• Communicate with providers for clarification or additional documentation as needed
• Works in collaboration with team members and other departments to meet departmental monthly goals

Senior Coder

• Reviews complex inpatient documentation at a highly skilled and proficient level to assign diagnosis and procedure codes utilizing ICD-10 CM/PCS, CPT, and HCPCS
• Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations utilizing an EMR and/or Computer Assisted Coding software
• Responsible for coding high dollar and long length of stay cases for all patient types
• Serves as a subject matter expert to Coding department leaders and peers
• Recommends modifications to current policies and procedures as needed to coincide with government regulations
• Collaborates with the Clinical Documentation Improvement and Quality teams to ensure a match in the DRG and reconciles each Medicare case from a CDI perspective
• Responsible for clinician communication related to disease processes on a clinical level to ensure accurate coding
• Participates in payer audits and meetings by acting as a resource for coding-related audits, as requested

Inpatient Coder Specialist – Community Facility

• Accurately assigns diagnosis and procedure codes for inpatient facility and professional services.
• Performs necessary tasks within MHS GENESIS and other military coding systems.
• Accurately assign Evaluation and Management (E&M) codes, ICD-CM diagnoses, CPT and HCPCS, modifiers, and quantities derived from medical record documentation.
• Reviews encounter and/or record documentation to identify and resolve inconsistencies, ambiguities, or discrepancies.
• Assigns accurate codes based on provider responses to coding queries.
• Supports DHA coding compliance by performing due diligence in ethically and appropriately researching and/or interpreting existing guidance.
• Utilizes MHS computer systems to remotely access patient records and assign codes for patient encounters in support of other MTFs.
• Achieve and maintain DHA coding productivity and accuracy standards for the position.
• Educates and provides feedback to providers and clinical staff to resolve documentation issues to support coding compliance.
• Acts as a source of reference to medical staff having questions, issues, or concerns related to coding.
• Responds to provider questions and provides examples of appropriate coding and documentation reference(s).

Medical Coder II

• Coordinate/review the work of subordinate employees and assist with the training and continuing education programs.
• Code medical records utilizing ICD-10-CM and CPT-4 coding conventions.
• Review the medical record to assure specificity of diagnoses, procedures, and appropriate/optimal reimbursement for hospital and/or professional charges.
• Abstract information from medical records following established methods and procedures.
• Review the complex medical records and accurately code the primary/secondary diagnoses and procedures using ICD-10-CM and/or CPT coding conventions.
• Ensure quality and quantity of work performed through regular audits.
• Assist with research, development, and presentation of continuing education programs on areas of specialization.
• Maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes, and surgical techniques through participation in continuing education programs.

Medical Records Coder II – Outpatient

• Reviews and interprets medical information, physician treatment plans, course, and outcome to determine appropriate ICD-10 CM/CPT codes for diagnoses and procedures. ( 65%)
• Abstracts data elements to satisfy statistical requests by the hospital, health system, medical staff, etc. and enters all coded/abstracted information into designated system. ( 15%)
• Ensures efficient management of medical information and cash flow as it pertains to the unbilled coding report. ( 10%)
• Keeps informed of the changes/updates in ICD-10 CM/CPT guidelines by attending appropriate training, reviewing coding clinics and other resources and implementing these updates in daily work. ( 5%)
• Performs other duties as assigned or required. (5%)

Coder – Outpatient

• Independently perform complex, specialty-specific professional fee coding (CPT/HCPCS and ICD-10-CM) for physician services rendered in both office and hospital settings
• Ensure all coding adheres strictly to official guidelines (e.g., provided by AAPC or AHIMA), federal regulations (CMS), and organizational compliance standards
• Identify the need for formal clinical queries for documentation clarification when necessary for professional or facility records
• Maintain high accuracy and productivity standards appropriate to the complexity of the assigned workload
• May provide informal guidance to new coding staff on professional coding nuances

Coder II – Cardiology

• Independently perform complex, specialty-specific professional fee coding (CPT/HCPCS and ICD-10-CM) for physician services rendered in both office and hospital settings, ensuring expert application of modifiers and E/M guidelines
• Perform entry-level facility coding for simple outpatient encounters (e.g., diagnostic imaging, labs) and basic inpatient services (e.g., uncomplicated admissions, short stays) using ICD-10-CM and ICD-10-PCS, where applicable
• Ensure all coding adheres strictly to official guidelines (e.g., provided by AAPC or AHIMA), federal regulations (CMS), and organizational compliance standards
• Identify the need for formal clinical queries for documentation clarification when necessary for professional or facility records
• Maintain high accuracy and productivity standards appropriate to the complexity of the assigned workload
• May provide informal guidance to new coding staff on professional coding nuances

Medical Billing and Coding jobs in Louisiana

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