Medical Records Coder-Intermediate

Under direct supervision, responsible for conducting review of inpatient and outpatient coding, assuring coding compliance with federal regulations, and maintains up-to-date coding guidelines and coding policy changes. Performs all tasks required to facilitate medical billing to include abstracting complex patient related data from medical records and coding of diagnoses and procedures using the ICD-10 and CPT classification systems.

This position will be a hybrid position working remote and/or on campus. Candidate being considered would need to live within commuting distance of UT Health San Antonio. Upon hire candidate will be required to be onsite for orientation and training. Transition to remote work is contingent on meeting productivity and quality standards as determined by supervisor. Remote Coders may be required to occasionally attend on campus training and meetings. 

 

• Reviews, interprets, and assigns diagnostic and procedural codes based upon medical record documentation according to correct coding principles.  
• Provides skilled and specialized technical work in documentation and coding for medical billing, abstracts complex patient-related data from medical records and coding of diagnoses and procedures using ICD-10 and CPT codes.  
• Works coding related charge review and claim edits daily to ensure timely and accurate billing.  
• Researches and resolves coding related issues, and assists in meeting productivity and quality standards.  
• Verifies charge entry and physician notes for completeness to include abstracting and entering relevant medical information from the medical records; checks for required signatures; assures proper documentation guidelines are followed.  
• Review medical records and charge fee information from patient care area.  
• Contacts other facilities to obtain medical records and information needed to bill for services rendered.  
• Reviews EPIC queues and correct coding edits.  
• Codes diagnosis and procedures using classification coding systems.  
• Reviews charge documents for completeness.  
• Performs all other duties as assigned.  

• Proficiency in ICD-10 and CPT coding.  
• Fundamental understanding of medical terminology, anatomy and physiology.  
• Meticulous attention to detail and accuracy.  
• A solid customer service acumen and interpersonal skills to effectively work with both internal and external customers and responds to requests in a timely and respectful manner.  
• Strong verbal, written and interpersonal communication skills.  

EXPERIENCE:

• Three (3) years experience in medical record abstraction and coding is required. 

CERTIFICATION/LICENSES:

• CBCS Certified Billing and Coding Specialist: National Health Career Association Upon Hire Req OR
• RHIT Registered Health Information Technician Upon Hire Req OR
• RHIA Registered Health Information Administrator Upon Hire Req OR
• CCS Certified Coding Specialist Upon Hire Req OR

EDUCATION:

• High School Diploma or GED.

 
 

Benefits Overview


UT Health San Antonio offers an excellent benefits package for its employees. Employees who work at least 20 hours a week, with an appointment of at least 4.5 months, are eligible for benefits. 
Medical - UT SELECT Medical insurance is offered free for employees and administered by Blue Cross and Blue Shield of Texas. Family members can be added to the plan through payroll deduction. Employees and their dependents can also receive discounted copays and coinsurance when using UT Health Physicians, a network of 800 premier physicians including more than 100 specialists. Employees receive $50,000 of group term life insurance and $50,000 of basic accidental death and dismemberment insurance for free, with options to purchase additional employee and dependent coverage for both at group rates.
Dental - Three dental insurance plan options are available for employees and their families through Delta Dental Insurance Company, two PPOs and one dental HMO plan. Both PPO plans allow employees to choose any licensed dentist. 
Vision - Fully insured Vision Care benefits are offered by Superior Vision Services. Two vision plan options that offer either standard or enhanced vision benefits.
Disability - Employees can enroll in the Disability Insurance which provides income if a non-work related illness or injury prevents you f