Certified Coder

Certified Coder

SUMMARY : Reads and interprets medical record documentation to assign diagnosis codes, assigns CPT codes, and applies knowledge of payer reimbursement guidelines to ensure proper reimbursement. Performs related duties as required.

DUTIES & ESSENTIAL JOB FUNCTIONS : NOTE : The following are the duties performed by employees in this classification, however, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.

1. Adheres to the ICD-9-CM (International Classification of Diseases, 10th revision, Clinical Modification) coding conventions, official coding guidelines approved by the cooperating parties, the CPT (Current Procedural Terminology) rules established by the American Medical Association, and any other official coding rules and guidelines established for use with mandated standard code sets.

2. Selection and sequencing of diagnoses and procedures must meet the definitions of required data sets. Utilizes up-to-date versions of CPT and ICD-10-CM resources and remains current on changes in coding and billing standards.

3. Strives for the optimal payment to which the facility is legally entitled, remembering that it is unethical and illegal to maximize payment by means that contradict regulatory guidelines.

4. Consults physicians for clarification and additional documentation prior to code assignment when there is conflicting or ambiguous data in the health record.

5. Diagnosis coding must be accurate and carried to highest level of specificity; assigns and reports codes that are clearly and consistently supported by documentation in the health record.

6. Follow up status of charges held for clearance; work error reports.

7. Responsible for properly performing month end tasks within the established time-frame including running month end reports for each center assigned and tracking of cases that are not yet billed for the month.

8. Provides feedback and education to physicians regarding billing and documentation.

9. Works with the Billing & Collection team to resolve coding issues.

10. Performs professional fee and documentation audits for a wide variety of specialties.

11. Manage work files to resolve coding edits by researching and using the most up-to-date tools available in order to make the appropriate and compliant corrections for reimbursement.

MINIMUM QUALIFICATIONS :

Education : High School Diploma or equivalent required, Associate’s degree preferred.

Minimum Experience : Five years relevant coding experience.

Minimum Experience : Experience coding and auditing professional fee surgical procedures and office visits. Required

Licenses / Certifications : Certified Coding Specialist (CCS-P) or Certified Professional Coder (CPC) certification required from AHIMA or AAPC.

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