Position Type
Full Time
Education Level
High School

Job Shift
Day

Job Category
Health Care

Description

The Certified Coder provides expertise in classifying medical data related to diagnoses, procedures, and services from patient records, generally for either professional or facility coding.
The incumbent possesses proficiency in medical coding guidelines and regulations including compliance and reimbursement, allowing a coder to better handle issues such as medical necessity, claims denials, bundling issues, and charge capture. The incumbent understands how to integrate medical coding and payment policy changes into a practice’s reimbursement process.

Essential duties

Reviews medical record documentation to identify pertinent diagnoses/procedures that require code assignment.
Reviews the medical record to assure specificity of diagnoses, procedures, and appropriate optimal reimbursement for professional charges.
Effectively assigns ICD 9/10, CPT, HPCPS, or other codes as appropriate per coding guidelines. Assignment of DRG codes may be appropriate for inpatient coding environments.
Queries physicians when code assignments are not straightforward or when documentation in the record is inadequate, ambiguous, or unclear for coding purposes.
Keeps abreast of coding guidelines and reimbursement reporting requirements. Brings identified concerns to department leadership for resolution.
Maintains coding accuracy and productivity levels set by the department.
Abides by the Standards of Ethical Conduct set forth by the American Association of Professional Coders/American Health Information Management Association.
Completes appropriate continuing education requirements for any credentials held, as necessary.
Performs other duties as required.

Qualifications

High school diploma, or equivalent required; college degree in health information management preferred
3+ years’ experience in coding
Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) required. RHIA/RHIT preferred.