Medical Billing and Coding

• Our Coders review medical documentation, assign appropriate codes (ICD-10, HCPCS, CPT), and ensure compliance with coding standards, regulations, and company procedures.
• Serve as a resource for providers in understanding covered indications and the supporting documentation.
• Supports both technical and professional services in provider clinic as well as Ambulatory Surgery Centers (ASC) and in addition hospital professional services.
• Maintains a thorough understanding of National Correct Coding Initiative (NCCI) edits and relative value units as appropriate for the role.
• Understands and supports the Medicare and Commercial Carrier workflows related to daily coding and denial review and appeals management, including the preparation of supporting documents and information to support the appeal process.
• Monitors and validates physician charge capture.
• Self-motivated with the ability to work independently, multi-task, problem solve and make informed and accurate recommendations to medical professionals based on current information.
• Reviews medical documentation from physicians and other healthcare providers; assigns modifiers, diagnostic and procedure codes for symptoms, diseases, injuries, surgeries and treatments according to official classification systems and standards.
• Provide accurate and timely international classification of disease – tenth edition – clinical modification (ICD-10) - CM coding of diagnoses, Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) coding, and in accordance with official coding standards, regulatory coding compliance guidelines and company procedures.
• Review and audit medical record documentation accurately to reflect healthcare coding and to substantiate appropriate service reimbursement.

Coder, Provider Practice

• Execute tasks focused on revenue generation through account resolution for any company client.
• Review documentation to support or contest payer coding decisions for multiple facilities.
• Prepare clear, concise, and well-supported appeals where applicable, using all available documentation, coding guidelines, and regulatory references to defend billed claims and secure reimbursement on insurance accounts receivable.
• Investigate the root causes of denials and downgrades, as needed.
• Provide targeted training on coding practices to Currance team members, promoting accuracy, compliance, and efficiency in resolving coding-related issues.
• Participate in daily shift briefings and contribute actively.
• Resubmit corrected claims according to Federal, State, and payer-mandated guidelines.
• Research, analyze, and correct claim errors and rejections to ensure accurate resubmission and to avoid payer denials due to preventable errors.
• Escalate problematic accounts, recurring issues, or trends to Supervisor and recommend education or denial prevention measures to the client.
• Stay current on payer updates, process changes, and coding guidelines to maintain compliance with Federal, State, and payer requirements.
• Meet productivity standards while maintaining quality output.
• Communicate payer-specific issues to the team and management for timely resolution.
• Engage in continuous learning to remain up to date on coding and payer policies.

Denial Resolution Specialist

• 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

• 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

• Review medical documentation and assign appropriate codes (ICD-10, HCPCS, CPT)
• Ensure compliance with coding standards, regulations, and company procedures
• Resolve coding and denial review issues
• Participate in coding team meetings as a subject matter expert
• Provide training on coding guidelines to healthcare providers

Coder, Provider Practice – Endocrinology & Diabetes Self-Management

• 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 South Dakota

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Coder, Provider Practice

Denial Resolution Specialist

Inpatient Coder Specialist – Community Facility

Coder II – Cardiology

Coder, Provider Practice – Endocrinology & Diabetes Self-Management

Coder II – ENT, Audiology