Medical Coder

The medical coder, under the supervision of Manager of AMG (Atlantic Medical Group, our physician practices) Revenue Cycle, will play a key role in supporting the billing office operations. Addresses inquiries from the CBO team regarding the billing, coding, and claims submission process as it relates to coding rules and payer requirements.

1. Knowledge of CPT, ICD10, and HCPCS coding
2. Knowledge of Medical Terminology & Anatomy
3. Identify ICD 10 Codes as appropriate per CCI Guidelines
4. Ability to process charges through the electronic health record
5. Ability to work denials through multiple systems
6. Ability to explain the differences between correct coding and payer requirements
7. Ensures claims are submitted proper and timely by the provider and include the necessary modifiers and units
8. Ability to differentiate place of service between inpatient, outpatient, and observation
9. Identify coding trends for education and reports to Supervisor
10. Identifies trends with insurance related issues and reports to Supervisor
11. Ability to abstract appropriate CPT and ICD10 from medical record
12. Reviews and corrects issues, rejections and/or denials for place of service and CPT mismatches, pre and post op denials, missing diagnosis, age related, and modifiers
13. Knowledge of Medicare Annual Exams vs. Preventative visits
14. Proficiency in NDCs and Infusion drugs
15. Policy research to ensure correct coding
16. Knowledge of CMS guidelines, complying with medical coding guidelines and legal requirements to ensure compliance with federal and state regulations
17. Various duties as assigned by Manager and/or Supervisor

Qualifications for Internal Candidates

1. CPC Certification a must
2. Minimum of 2 - 5 years of medical coding experience required
3. Experience in Surgical coding preferred, but not required
4. Strong written and verbal communication skills
5. Ability to set and meet deadlines