Full Time (Monday-Friday/40 hours per week)
The medical coding professionals at OS inc support the importance of accurate, complete and consistent coding practices for the production of quality healthcare data. The medical coder is responsible for the assignment of accurate ICD-10 codes based on documentation in the medical record for both institutional and professional services/visits. The goal is to strive for optimal reimbursement. The medical coder may also be responsible for denial and appeal management of received claims.
The medical coder pulls specific details -- such as patient medical history, test results, diagnoses and treatment recommendations -- from physician notes, test reports, diagnosis forms and other related documents. The medical coder assigns abbreviated references in the form of predetermined codes to the data and enters it into fields in computer applications, such as electronic patient record management and billing software. As needed the medical coder contacts sources of information to clarify information that is not clear or in error, and updates databases and forms as needed.
ESSENTIAL DUTIES AND RESPONSIBILITIES include but are not limited to the following:
Procedure and Diagnosis Coding:
- Assignment or verification of CPT, HCPCS, ICD-10 CM, ICD-10-PCS coding and modifiers based upon documentation.
- Sequences diagnoses and procedure codes as outlined in the ICD Official Coding Guideline.
- Resolve edits for electronic charges following established policies and procedures to ensure all data elements (claim requirements – CPT, ICD-10 CM, modifiers, provider, codes complex inpatient procedures and diagnoses using International Classification of Diseases (ICD) and Procedure Coding System (PCS) coding protocols. Follows the prescribed organization's coding guidelines, and quality and productivity standards.
- Reviews all provider documentation to include review of patient histories, physical examinations, emergency room visits, procedures, consultation and discharge summaries to support assigned codes in the health information record so that all significant diagnoses and procedures may be captured for reimbursement, statistical, research, severity and data purposes.
- Follows up and obtains clarification on inaccurate documentation as appropriate.
- Applies Medical Severity Diagnosis Related Groups (MS-DRGs) and/or Ambulatory Patient Categories (APCs) in order to code charts for accurate hospital bill preparation. Reviews MS-DRG information from nursing worksheets for accuracy. Forwards inaccurate information to appropriate leader as needed.
- Abides by the 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.
- Review all denials on an explanation of benefits (EOB) and work on issues/errors until resolved.
- Submit required appeals when needed. Identify, report and resolve coding and reimbursement issues.
- Work with the director of operations and other billing and reimbursement staff. Identify opportunities to reduce denials and enhance revenue.
- Perform all functions related to the collection of delinquent accounts, to include follow up phone calls and resubmission of claims to third party payers.
Responsible for identifying trends on coding and documentation practices. Offers suggestions for improvements. Works directly with clients HIM departments.
Medical coders play a key role in ensuring that a health care provider meets regulations that govern recordkeeping. It’s the medical coder’s job to protect patient privacy by keeping medical histories confidential. Plus, medical coders review records to determine if the records contain the personal information and treatment details the law requires. When agencies, health professionals or insurers ask about patient specifics, coders must know legal rules governing the release of that information. Medical coders also serve as liaisons between the provider and the billing office.
The medical coder maintains the confidentiality of patient records. Reports any perceived non-compliant practices to the compliance manager.
The medical coder is expected to regularly review updates to coding classification manuals and related software. She/he must stay up to date on medical information that can help her assign correct codes, such as terminology, diseases, disorders, treatment methods and medications. The medical coder is also expected to review federal, state, facility, healthcare system and third-party changes to medical records, and other rules and policies.
Certificates, Licenses, Registrations:
Current coding certification from the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC)
- AHIMA preferred credentials
- RHIA (Registered Health Information Administrator)
- RHIT (Registered Health Information Technician)
- CCS (Certified Coding Specialist)
- CCS-P (Certified Coding Specialist—Physician-based)
- AAPC preferred credentials
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder)
Education and/or Experience:
- High school diploma or equivalent.
- Additional specialized education in coding or combination of education and experience
- Minimum one- year experience as a medical coder, outpatient setting preferred
Knowledge and Skill:
- Knowledge and experience with different EMR – Ability to be technically proficient in various EHR’s and practice management software as determined by client project.
- Experience preferred with various physician specialties, acute care hospital, ER, critical access hospital and rural health clinics. With emphasis on facility coding.
- Demonstrated knowledge and understanding of anatomy, physiology, medical terminology, and pathophysiology (disease process, surgical terminology and pharmacology) and is able to apply these sciences to accurately assign codes to complex cases.
- Advanced knowledge of pharmacology indications for drug usage and related adverse reactions.
- Ability to work with a high degree of accuracy and give attention to detail of the repetitive nature.
- Ability to work independently and work collaboratively with others.
- Ability to meet deadlines while working in a fast-paced environment, and to exercise independent judgment.
- Notable client service, communication, presentation and relationship building skills required.
- Ability to function independently and as a team player in a fast-paced environment required.
- Must have strong written and verbal communication skills.
- Computer skills including experience with Microsoft Office or similar applications.
- Excellent communication and reading comprehension skills.