Medical Billing and Coding

• Reviews documentation and assigns appropriate ICD-10, CPT and HCPCS codes.
• Assigns appropriate primary diagnosis after deciding what was chiefly responsible for the encounter.
• Assigns appropriate modifiers according to guidelines.
• Finalizes the appropriate data for accounts.
• Clarifies documentation or diagnosis by communicating with the physician.
• Ensures weekly, monthly, and quarterly department goals are met.
• Makes recommendations to the Billing and Coding Manager for process and quality improvement.
• Maintains knowledge of current coding rules and trends for coding types assigned by attending seminars, workshops and watching webinars.

Medical Coder

• Reviewing documentation and selecting the appropriate procedure and/or diagnosis code to be entered in billing documents
• Ensuring that teaching physician requirements are met and are clearly reflected in the documentation
• Other duties as assigned

Certified Coder – Practice Operations, Certified Professional Coder

• 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

• Responsible for accurate and timely assignment of ICD 10 CM/PCS and HCPCS/CPT codes.
• Payment group classification assignment and data abstraction for reimbursement purposes.
• Reviews and interprets Inpatient, Outpatient, Ancillary, Diagnostics and Emergency Medicine records.
• Performs coding and abstracting tasks to support data quality and statistics.
• Utilizes information on diagnostic reports to accurately code patient charts.
• Works within service line structure based on patient type.
• Provides all necessary coded and abstracted information required for final coding and billing.

Coder III

• Identify opportunities to improve provider documentation and create an education plan tailored to each assigned provider
• Arrange educational sessions with assigned providers aimed at quality of care and documentation improvements
• Prepare comprehensive reports and presentations on coding quality trends, risk areas, and educational outcomes using data visualization techniques
• Provider onsite education, based on business needs
• Collaboration with other market provider facing role
• Use data analytics tools to assess coding quality, identify error patterns, and monitor compliance with internal and external standards
• Analyze coding audit results and other relevant data to develop data-driven educational materials and interventions
• Participate in cross-functional teams to improve documentation, data integrity, and workflow processes

Certified Coder – Practice Operations – Part-Time

Coder – Outpatient, Part-Time

• Ability to comprehend medical record documentation to accurately assign codes for both concurrent and discharged accounts across multiple specialties.
• Meets minimum requirements for production and quality monthly.
• Requires a working knowledge of code sequencing for grouper-related payers with attention to detail to avoid rework and waste with charge capture assessment component.
• Requires understanding and application of M.E.A.T. criteria (i.e., monitoring, evaluation, assessment, treatment) using ICD 10 CM transaction data set to capture diagnoses.
• Analyzes high-risk encounters for accurate and/or missing charges gaps prior to encounter completion (i.e., missing charges from anesthesia, surgery) when manual charge capture occurs.
• Understand complexity of billing requirements and incorporates payer specific trends into day-to-day reviews to reduce “take backs” associated with un-clear, or un-substantiated care rendered.
• Requires excellent coding knowledge of ICD 10 CM, CPT 4, and modifier application, with expectations to maintain certification (i.e., CCS, CPC, RHIT, or RHIA) and apply ICD 10 CM Coding Guidelines specific to both inpatient and outpatient encounters.
• Facilitate modifications to clinical documentation through query interaction to ensure that the information captured supports the level of service rendered, with attention towards chronic conditions, hierarchical condition categories (HCC), and risk adjustment factors (RAF).

Inpatient Coder

• Ability to comprehend medical record documentation to accurately assign codes for both concurrent and discharged accounts across multiple specialties.
• Meets minimum requirements for production and quality monthly.
• Requires a working knowledge of code sequencing for grouper-related payers with attention to detail to avoid rework and waste with charge capture assessment component.
• Requires understanding and application of M.E.A.T. criteria (i.e., monitoring, evaluation, assessment, treatment) using ICD 10 CM transaction data set to capture diagnoses.
• Analyzes high-risk encounters for accurate and/or missing charges gaps prior to encounter completion (i.e., missing charges from anesthesia, surgery) when manual charge capture occurs.
• Understand complexity of billing requirements and incorporates payer specific trends into day-to-day reviews to reduce “take backs” associated with un-clear, or un-substantiated care rendered. (i.e., varying modifier assignment for EAPG vs. Non-EAPG payer specificity)
• Requires excellent coding knowledge of ICD 10 CM, CPT 4, and modifier application, with expectations to maintain certification (i.e., CCS, CPC, RHIT, or RHIA) and apply ICD 10 CM Coding Guidelines specific to both inpatient and outpatient encounters.
• Facilitate modifications to clinical documentation through query interaction to ensure that the information captured supports the level of service rendered, with attention towards chronic conditions, hierarchical condition categories (HCC), and risk adjustment factors (RAF).
• Demonstrates an excellent working knowledge of hospital information systems to retrieve data specific information (i.e., order diagnosis, patient type) within a complicated filing schema including non-hospital data (i.e., Media Tab, Office Visits etc)

Facility ED Coder

• identify opportunities to improve provider documentation and creates an education plan tailored to each assigned provider
• report to the Manager, Medicare Risk Adjustment
• arrange educational sessions with assigned providers aimed at quality of care and documentation improvements
• identify educational needs based on reports
• prepare comprehensive reports and presentations on coding quality trends, risk areas, and educational outcomes using data visualization techniques
• provider onsite education, based on business needs
• collaboration with other market provider facing role
• use data analytics tools to assess coding quality, identify error patterns, and monitor compliance with internal and external standards
• analyze coding audit results and other relevant data to develop data-driven educational materials and interventions
• participate in cross-functional teams to improve documentation, data integrity, and workflow processes

See all jobs on JobTailor

Medical Coder

Certified Coder – Practice Operations, Certified Professional Coder

Coder – Outpatient

Coder III

Medical Coder

Certified Coder – Practice Operations – Part-Time

Coder – Outpatient, Part-Time

Inpatient Coder

Facility ED Coder

Medical Coding Educator