Coder

Job Title: Medical Coder

Job Summary: The Medical Coder plays a crucial role in the healthcare industry by accurately translating medical diagnoses, procedures, and services into universal alphanumeric codes. This ensures proper billing, reimbursement, and compliance with regulatory requirements. The Medical Coder reviews patient medical records and assigns appropriate codes according to established coding guidelines and healthcare regulations.

Responsibilities:

1. Review patient medical records to accurately abstract and assign diagnostic codes (ICD-10-CM) and procedural codes (CPT, HCPCS) based on physician documentation.
2. Ensure coding accuracy and compliance with coding conventions, official coding guidelines, and regulatory requirements such as HIPAA and CMS regulations.
3. Query physicians or other healthcare providers for clarification or additional documentation when necessary to accurately assign codes.
4. Analyze medical records and clinical documentation to identify discrepancies or potential coding issues and take appropriate corrective actions.
5. Adhere to coding productivity and accuracy standards set by the organization or industry benchmarks.
6. Stay updated on changes and updates to coding guidelines, regulations, and reimbursement methodologies.
7. Collaborate with other members of the healthcare team, including physicians, nurses, and healthcare administrators, to ensure accurate coding and billing practices.
8. Assist with coding-related audits, compliance reviews, and quality improvement initiatives.
9. Maintain confidentiality of patient health information and ensure compliance with privacy and security regulations.
10. Provide coding expertise and support to billing and revenue cycle management staff as needed.
11. Participate in ongoing professional development activities to enhance coding knowledge and skills.

Qualifications:

1. High school diploma or equivalent required; Associate's or Bachelor's degree preferred.
2. Certification as a Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or similar coding credential from a recognized professional organization (e.g., AAPC, AHIMA).
3. Proficiency in medical terminology, anatomy, physiology, and disease processes.
4. Strong understanding of coding guidelines and regulations, including ICD-10-CM, CPT, and HCPCS Level II coding systems.
5. Excellent attention to detail and accuracy in coding assignments.
6. Ability to interpret and analyze complex medical documentation.
7. Strong communication and interpersonal skills, with the ability to effectively communicate with physicians and other healthcare professionals.
8. Proficiency in using coding software and electronic health record (EHR) systems.
9. Ability to work independently and efficiently in a fast-paced environment.
10. Familiarity with insurance reimbursement processes and billing requirements is a plus.

Experience: Previous experience in medical coding or healthcare documentation is preferred, but entry-level positions may be available for candidates with relevant education and certification.

Working Conditions: Medical Coders typically work in office settings within hospitals, clinics, physician offices, or healthcare billing companies. They may work regular business hours or have flexible schedules depending on the employer's needs. Remote work opportunities may also be available in some cases.