Coder

The Coder is responsible for successfully and efficiently coding all cases to the highest level of accuracy to ensure maximum reimbursement. The Coder will ensure quality and productivity standards are met. The Coder will ensure accurate coding of documentation to include diagnoses, procedures, and modifiers with adherence to established coding guidelines for both government and third-party payers. They work with the Coding Supervisor to escalate coding issues and prevent untimely claim submission and denials.

ESSENTIAL JOB FUNCTION/COMPETENCIES

• Reviews chart documentation for accuracy and completeness, identify inconsistencies in chart documentation, and work with appropriate staff and Coding Supervisor to resolve issues
• Communicates with Claims Resolution Specialists and Business Office staff when necessary to resolve errors and clarify issues
• Demonstrates and use in-depth knowledge of CPT, HCPCS, modifiers, diagnosis codes, insurance coverage plans, medical terminology, and anatomy and physiology
• Works collaboratively with providers to obtain complete documentation to support coding
• Stays accountable to quality and productivity standards, and monitor compliance with policies and procedures
• Identifies process opportunity trends and recommend ways to improve efficiencies
• Responsible for maintaining current knowledge of coding guidelines and relevant state and federal regulations
• Ensures adherence to third party and governmental regulations relating to coding, documentation, compliance, and reimbursement
• Participates in special projects, personal development training, and cross training as instructed
• Informs Coding Supervisor of trends, inconsistencies, discrepancies, or payer changes for immediate resolution
• Works in conjunction with peers and functional areas of the Coding and Revenue Integrity department for the betterment of completing tasks and the company overall
• Job may require other duties as assigned

CERTIFICATIONS, LICENSURES OR REGISTRY REQUIREMENTS

• CPC, CCS-P, CMRS or AAPC required.

KNOWLEDGE | SKILLS | ABILITIES

• Demonstrates understanding of business and how actions contribute to company performance
• Demonstrates excellent customer service skills
• Knowledge of medical terminology, Current Procedural Terminology (CPT), International Classification of Disease (ICD) coding, and the entire revenue cycle process
• Knowledge of EHR (Electronic Health Record) software systems and Microsoft Office products
• Professional verbal and written communication skills
• Ability to develop reports and create presentations
• Ability to work collaboratively across disciplines and business lines
• Must be comfortable working with team members
• Ability to handle multiple tasks with excellent problem-solving skills
• Strong analytical skills with ability to make conclusions and recommendations
• Well organized with the ability to maintain accuracy and confidentiality
• Self-driven and motivated to maintain productivity and efficiency levels

EDUCATION REQUIREMENTS

• High school diploma or general education degree; or equivalent combination of education and experience.

EXPERIENCE REQUIREMENTS

• At least 3 years’ experience to successfully perform this job
• Entry level Medical Billing and Coding Terminology preferred
• Experience in Urology or physician practice environment preferred