Certified Professional Coder - Manning - Coding

Schedule: Monday - Friday
Pay Range: $19.33 - $26.58 Depending on Years of Experience


JOB PURPOSE: The Certified Professional Coder coordinates and performs the implementation of concurrent coding and querying processes, as well as performing administrative and fiscal duties, tasks, and assignments in support of the Business Office Department and its varied operations. A Certified Professional Coder is responsible for the translation of healthcare providers’ diagnostic and procedural phrases into coded form, as well as the review and interpretation of health record documentation to ensure accurate coding services are rendered and submitted. A Certified Professional Coder ensures that all technical aspects of the assignment of diagnostic and procedural coding are carried out in accordance with established standards and comply with CMS, NCQA, third-party payers, and other regulatory agencies. The incumbent will support and assist in the training and education of Coding Assistants in the use of organizational software applications, which support and facilitate concurrent coding. Performing the functions and requirements for this position follows standardized procedures and policies requiring limited judgment in their execution and will always remain within the defined scope for the position.
An employee in this position works with general supervision and review, and any work problems involving departures from standard policies, interpretations, or procedures are presented to the supervisor for resolution.
The primary goal of the El Rio Health Certified Professional Coder is to support El Rio’s Mission of providing comprehensive, quality health care that is affordable and accessible to all who may have healthcare needs, by successfully performing the primary essential functions.
Essential Job Functions:
• Performs administrative, technical, and fiscal duties, tasks, and assignments supporting Business Office operations within established periods; meeting established rates of performance for the quality and quantity of work for the position; demonstrating a level of quality, efficiency, and accuracy in the employee’s job performance that ensures the highest standards of excellence.
• Maintains at all times patient confidentiality by controlling the information being disclosed to authorized individuals ensuring compliance with all HIPAA and corporate compliance standards, as well as generally accepted confidentiality standards.
• Performs the specialized technical skills to complete all assigned coding processing duties, tasks, and responsibilities, in addition to working successfully with all organizational operating systems, and/or business software, such as:
◦ Reviews complex medical records and accurately codes the primary/secondary diagnoses and procedures using ICD and/or CPT coding conventions;
▪ Analyzes provider documentation to assure the appropriate Evaluation and Management levels are assigned using the correct CPT code;
▪ Identifies incomplete documentation in the medical record and formulate a provider query to obtain missing documentation and/or clarification and provide education to providers to accurately complete the coding process;
▪ Reviews records for compliance with established third-party reimbursement agencies and special screening criteria;
◦ Utilizes standard coding guidelines, principles and coding standards to assign the appropriate ICD and CPT codes for all record types ensuring accurate reimbursement;
◦ Contacts providers or clients as appropriate when documentation in the medical record is inadequate, ambiguous, or unclear for coding purposes;
◦ Reviews all coding entries for accuracy and completeness prior to submission to billing system;
◦ Collaborates with staff on resolution of outstanding appeals pending with insurance payers in order to expedite resolution of accounts.
• Provides support and instruction to internal clients regarding financial reimbursement, evaluation of International Classification of Diseases (ICD) and/or Current Procedural Terminology (CPT) coding, supporting improvement in provider documentation, coding and other regulatory compliance for commercial and managed care payers; as well as reimbursement methodologies.
◦ Provides real-time feedback to providers as it pertains to: proper coding and clinical documentation of services performed, coding issues, and reviewing denials;
◦ Evaluates and identifies front-end and back-end error trends for training utilization, bringing them to the attention of the supervisor.
• Coordinates the work of designated Coding Assistants ensuring the quality and quantity of work performed meets the established departmental and organizational standards through regular audits.
• Demonstrates an understanding of and