Medical Billing and Coding

• 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

• Review medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries to verify accuracy, completeness, specificity, and appropriateness of diagnosis codes
• Assist with validation audits to evaluate medical record documentation to ensure coding accurately reflects and supports relevant coding based on the ICD-10 code submitted to CMS for reimbursement
• Interpret medical documentation to ensure all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions applicable to Medicare Risk Adjustment reimbursement initiatives is captured
• Develop tools and metrics to improve accuracy and completeness of coding and documentation
• Provide a high level of customer service to internal and external clients by meeting and/or exceeding expectations including quality and productivity standards
• Escalate appropriate coding audit issues to management as required
• Participate in and support ad-hoc coding audits as needed
• Support ongoing programs which minimize organizational risk in the event of a Risk Adjustment Data Validation (RADV) Audit
• Work assigned coding projects to completion
• Other duties as assigned

Medicare Risk Adjustment Coding Specialist

• 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

• 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

Medical Coder

• 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

Coder II – ENT, Audiology

• Apply appropriate coding classification standards and guidelines to medical record documentation for accurate coding
• Resolve medical record documentation deficiencies through healthcare provider query, and provide routine feedback to healthcare providers to correct deficiencies
• Perform quality assessment of records, including verification of medical record documentation (both electronic and handwritten)
• Responsible for researching errors or missing documentation from medical record, in order to provide accurate coding processes
• Abstract and assign the appropriate ICD-10, HCPCS/CPT codes; including Level I & Level II modifiers as appropriate for all diagnosis and procedures performed in an outpatient and inpatient setting.

Coder, Pro

• Process claims to appropriate primary, secondary, and/or tertiary insurance company according to insurance guidelines
• Perform follow-up on unpaid insurance accounts identified through aging reports
• Process appeals when appropriate
• Process refund requests
• Identify trends, and carrier issues relating to billing and reimbursements, report findings to leadership
• Maintain Privacy & Confidentiality of patient information and organizational operations
• Responsible for learning, understanding and following payer guidelines
• Reallocate misapplied payments and adjustments
• Work special assignments when needed

Medical Billing & Collections Specialist

• Responsible for assigning appropriate diagnostic and procedural codes to patient charts of moderate to high complexity using ICD-10-CM, ICD-10-PCS, CPT, HCPCS or any other designated coding classification system in accordance with coding rules and regulations.
• Abides by the Standards of Ethical Coding as set forth by AHIMA.
• The Outpatient Coder shall review hospital outpatient medical documentation or physician medical record documentation to assign, sequence, edit and/or validate the appropriate ICD-10-CM, CPT and HCPCS codes with outpatient encounters to ensure proper coding, billing and compliance.
• Will match outpatient coding area to experience (i.e. Same Day Surgery, Routine Outpatient, Physician, Recurring, Observation, etc.).
• Reviews encounter to assign and sequence appropriate diagnoses and/or procedure codes as well as modifiers to diagnostic, physician and/or surgical encounters in accordance with Official Coding Guidelines, CMS regulations, Local Medical Review Policy (LMRP), guidance in encoder software and HIM coding policies and procedures.
• Using 3M encoder, reviews Ambulatory Payment Classifications (APC) and coding edits.
• Reviews Local/National Coverage Determination (LCD/NCD) edits and guidance for codes meeting medical necessity.
• Research electronic medical record for any additional diagnoses documented to meet medical necessity.

Outpatient Acute Care Coder – Emergency

Certified Coder – Practice Operations – Part-Time

• Apply appropriate coding classification standards and guidelines to medical record documentation for accurate coding.
• Perform quality assessment of records, including verification of medical record documentation (both electronic and handwritten).
• Perform quality assessments of coders completed work to validate standards are met.
• Educate coders and other staff on appropriate coding guidelines.
• Responsible for researching errors or missing documentation from medical records in order to provide accurate coding processes.
• Abstract and assign the appropriate ICD-10, HCPCS/CPT codes; including Level I & Level II modifiers as appropriate for all diagnosis and procedures performed in outpatient and inpatient settings.
• Assist in the development and ongoing maintenance of processes and procedures for each assigned client revolving around system use, billing/coding rules, and client specific guidelines.
• Manage time effectively to meet all required deadlines and timeframes for client and department needs.
• Collaborate in a team environment with the Department Manager and other staff on a regular basis.
• Ensure compliance with all relevant regulations, standards, and laws.

Medical Coding Quality Analyst

•Analyze, audit and resolve claims outstanding, denied, or incorrectly paid
•Review and respond to payer correspondence.
•Submit appeals as needed for denied claims.
•Contact insurance companies and navigate payer websites in order to secure and expedite insurance payments.
•Resolves patient billing inquiries.
•Document in detail all actions taken in accounts receivable system.
•Meet productivity expectations as outlined by supervisor.
•Recognize, document and notify Team Lead of trends resulting in nonpayment or incorrectly paid claims.
•Answer and resolve inbound calls from insurance carriers.
•Participate in process improvement initiatives as needed.
•Keep current with Medicare and other third party administrators regulations and procedures.
•Manage any special projects requested by supervisor or team lead.
•Must be able to perform the essential functions of this position with or without reasonable accommodation.

Medical Billing Insurance Specialist

• 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

• Assign diagnosis and procedure codes using the appropriate coding classification system on all episodes of care in the emergency department, same-day surgery, outpatient clinic, observation, inpatient OB/newborn hospital, specialty clinic encounters according to coding conventions, guidelines, and hospital policy.
• Ensure compliance with official guidelines (ICD-10-CM, AHA Coding Clinic, AMA CPT Assistant and Guidelines), AHIMA Standards of Ethical Coding, and LifePoint Health Support Center (HSC) policies and procedures.
• Achieve and maintain 95% accuracy on quality reviews and assigned productivity standards.
• Maintain knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the coding area.

Outpatient Coding Specialist – Surgery

• Responsible for assisting the coding department with the day-to-day non-coding duties support activities
• Assigns codes to office-based visits and procedures using the International Classification of Diseases (ICD-10-CM), Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS)
• Resolve coding edits to assure accurate and complete claims submission
• Sequences diagnoses and procedure codes as outlined in CPT, ICD-10-CM, and HCPCS Coding Guidelines while adhering to local and national governmental payer guidelines
• Reviews all clinician documentation to support assigned codes in the health information record
• Follows up and obtains clarification of inaccurate documentation as appropriate
• Codes risk adjustable encounters, resolves CRMs, and trends coding denials, as assigned
• Conducts formal coding and documentation reviews, clinician reviews and quality reviews, as assigned
• Assists with coding research functions and education activities
• Creates clinician coding and documentation education based on query trends or ad-hoc requests
• Adheres to the organization and departmental guidelines, policies, and protocols.
• Abides by Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines.
• Practices ethical judgment in assigning and sequencing codes for proper insurance reimbursement
• Maintains confidentiality of patient.

Physician Support Coder

• Responsible for critical access hospital coding; including emergency department, infusions, Critical Access Hospital Specialty Clinic, professional fees, and Rural Health Clinic.
• Ensure the timely and accurate coding of medical claims while maximizing reimbursement for services.
• Receive and review charge entry data from practice sites.
• Identify and investigate incomplete or missing charges.
• Abstract clinical information; translate medical documentation into diagnoses and procedural codes while utilizing currently accepted coding and classification systems.
• Sequence codes according to established guidelines.
• Maintain current knowledge of coding rules and regulations as designated by the AMA, Centers of Medicare and Medicaid Services (CMS) and other payers.
• Maintain proficient knowledge of EHR, as well as any other systems to perform job duties.
• Communicate issues to management, including payer, system, or escalated account issues.
• Identify medical necessity denial trends and provide suggestions for resolution.
• May perform other billing functions including claim submission, unpaid claims follow-up, denial resolution.
• Participation in department meetings, in-service programs, and continuing education programs.
• Convey professional attitude with patients, visitors, physicians, office staff and hospital personnel.
• Assure confidentiality of patient information, maintaining compliance with policies and procedures.
• Perform other duties as assigned.

Coder

• 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.
• Review complex medical records and accurately code primary/secondary diagnoses and procedures using ICD-10-CM and/or CPT coding conventions.
• Coordinate/review the work of designated employees.
• Ensure quality through regular audits.
• Consult and educate physicians on coding practices.

Medical Records Coder II

• 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

• Perform coding and related duties using established billing office policies in an accurate and timely manner.
• Primary contact with physicians, department administrators, hospital and/or clinical department administrators and their support staff and billing staff.
• Coordinates professional service billings for selected clinical departments.
• Assignment or verification of CPT, ICD-10 CM coding and modifiers based upon documentation.
• Resolve edits for electronic charges, following established policies and procedures to ensure that all data elements are applied.
• Monitor charge flow and act as a liaison with managers, department administrators and other billing personnel.
• Identify, report, and resolve coding and reimbursement issues.

Coding Specialist II – Radiation Oncology

• Perform coding and related duties using established billing office policies in an accurate and timely manner.
• Primary contact with physicians, department administrators, hospital and/or clinical department administrators and their support staff and billing staff.
• Coordinates professional service billings for selected clinical departments.
• Assignment or verification of CPT, ICD-10 CM coding and modifiers based upon documentation.
• Resolve edits for electronic charges, following established policies and procedures to ensure that all data elements (claim requirements – CPT, ICD-10 CM, modifiers, provider, billing area, etc.) are applied.
• Monitor charge flow and act as a liaison with managers, department administrators and other billing personnel to assure consistent and accurate change flow.
• Identify, report, and resolve coding and reimbursement issues.
• Develop and maintain all protocols related to their assigned areas.
• Maintain understanding all Teaching Physician and provider documentation policies.
• Actively participate in new provider orientations.

Coding Specialist II – Psychiatry

• Conducting coding audits prior to payment release.
• Performing post-payment coding reviews with overpayments.
• Sending coding education correspondence to applicable providers.
• Reviewing medical records, patient medical history and physical exams.
• Assisting with validation audits to evaluate medical record documentation.
• Interpreting medical documentation to ensure coding captures HCC conditions.
• Developing tools and metrics to improve coding and documentation accuracy.
• Providing high level of customer service to internal and external clients.
• Escalating appropriate coding audit issues to management.
• Participating in and supporting ad-hoc coding audits as needed.
• Supporting ongoing programs to minimize organizational risk in RADV Audits.
• Completing assigned coding projects.
• Other duties as assigned.

See all jobs on JobTailor

Certified Coder – Practice Operations, Certified Professional Coder

Medicare Risk Adjustment Coding Specialist

Coder II – Cardiology

Medical Coder

Coder II – ENT, Audiology

Coder, Pro

Medical Billing & Collections Specialist

Outpatient Acute Care Coder – Emergency

Certified Coder – Practice Operations – Part-Time

Medical Coding Quality Analyst

Medical Billing Insurance Specialist

Inpatient Coder

Outpatient Coding Specialist – Surgery

Physician Support Coder

Coder

Medical Records Coder II

Facility ED Coder

Coding Specialist II – Radiation Oncology

Coding Specialist II – Psychiatry

Medicare Risk Adjustment Coding Specialist