Inpatient-Outpatient Coder

Position Overview

The Inpatient-Outpatient Coder is responsible for conducting coding audits and education for providers with greatest opportunity for improvement. This individual will ensure medical diagnosis and procedure codes submitted on provider claims are accurate. In addition, this person will review medical records for : physician documentation, clinical evidence that supports the diagnoses, medical necessity of procedures, appropriate setting of care and accurate use of CMS coding guidelines.

Scope of Role & Responsibilities

• Identifies trends and inconsistencies in provider documentation and coding practices.
• Audits and reviews medical records to determine if the medical record is complete, accurate, and in support of individual patient risk adjustment score accuracy.
• Develops curriculum to improve provider coding practices.
• Educates providers and their practice staff in coding guidelines.
• Works in collaboration with other departments, develop plans and materials that support education and system changes to ensure proper coding is a standard practice for all providers.
• Participates in the review and analysis of summary data. Assist with data collection and report generation.
• Maintains the confidentiality and security of sensitive information and files.

Required Education, Training & Professional Experience

Licensure and / or Certification Required

Professional Competencies