Medical Coder/Coding Specialist

Employee Type:

Regular

Work Shift:

Day - 8 hour shift (United States of America)

Join Team Tidelands and help people live better lives through better health!

Position Summary: Responsible for analyzing and assigning ICD-10-CM diagnostic codes, CPT, and HCPCS codes to all outpatient, ED, and hospitalists accounts, based on the medical information provided and consistent with regulatory guidance and best practices in the industry and Tidelands Health policy and procedure. Abides by the Standards of Ethical Coding as set forth by AHIMA and AAPC. Abstracting required clinical information from the medical record. Queries physicians as needed, to clarify documentation to ensure accurate code assignment. Organizes and prioritizes work to meet deadlines and goals. Maintains and expands knowledge of coding and sequencing guidelines to ensure coding compliance and accuracy. Responsible for resolving coding edits, account checks, rejections, and denials to ensure proper reimbursement of service rendered and to maintain an industry standard clean claim rate. May assistant with writing appeals letters. Assist with training to include team members and physicians.

Position Responsibilities & Functions:

• Applies strong knowledge of anatomy and physiology, clinical disease processes, pharmacology, and diagnostic and procedural terminology to determine the appropriate assignment of diagnosis and procedure codes.

• Analyzes medical records, interprets documentation, and assigns proper International Classification of Diseases, Tenth Edition Clinical Modification (ICD‑10‑CM), Current Procedural Terminology/HealthCare Common Procedure Coding System (CPT/HCPCS), modifiers, and Evaluation & Management codes utilizing designated software to include Computer Assisted Coding (CAC) and/or encoder, coding manuals and other reference material as required.

• Enters charges for procedures that are not soft coded as instructed for certain patient types.

• Adheres to all department coding/charging procedures, policies, guidelines, and quality standards.

• Consistently meets coding quality and productivity standards established by the coding department.

• Completes a daily basis case that have been assigned to them utilizing the appropriate work lists/work queues.

• Codes complex diagnostic and procedural accounts, which include but are not limited to the following:

  • Emergency Services, Hospitalist Services, Observation, Same day surgery, Clinical Accounts, Recurring

• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association/American Association of Procedural Coders and adheres to official coding guidelines.

• Meets revenue cycle goals (Key Performance Indicators (KPIs) and Productivity Standards).

• Works closely with Patient Financial Service (PFS) to review documentation and serve as department expert on coding questions.

• Have knowledge of payer guidelines related to MUE, Medical Necessity, LCD/NCD requirements and HIPAA/Compliance in order to take corrective actions to allow for payer processing for payment.

• Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer or contract.

• Review and resolve account checks, clearinghouse rejection errors, denials, and charge review/claim edits daily.

• Assist Patient Financial Service (PFS) with written appeal letters, dispute determination responses, and redetermination to support reimbursement of services rendered.

• Collaborate with the Compliance/Quality Team when alerted to coding quality issues found via internal or external reviews; implement with accuracy coding quality recommendations.

• Work with HIM operations as needed to clarify queries and documentation needs for the completion of the medical record.

• Verify accurate abstracting of discharge disposition

• Reviews accounts returned from various departments and processes corrections for clean claim submission or posts claim denial review for appeal.

• As assigned, assists in training new coders to become acclimated to the environment and in understanding internal coding policies and procedures, and documentation guidelines.

• Assists manager with special projects/other tasks as assigned

• Safeguards confidential and privileged patient information.

Other duties as assigned:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee partn