[Hiring] Coder I - MPG - FT - Days - MSS - Remote Eligible @Memorial Healthcare

Role Description

Reviews medical record documentation. May assign codes to medical diagnoses, procedures and modifiers, when applicable, using appropriate coding classifications for assigned areas/record types to ensure proper billing and compliance.

• Communicates with insurance companies about coding errors and disputes (physician billing).
• Abstracts pertinent data points for billing and quality reviews.
• Communicates with various departments as needed to ensure accuracy of patient data.
• Conducts audits and/or coding reviews with various health care professionals to ensure all documentation is accurate (physician billing).
• May assign and sequence basic CPT (Current Procedural Terminology) procedure codes (non-complex), and modifiers based on medical record documentation in accordance with Official Coding Guidelines, CMS regulations, Local Medical Review Policy (LMRP) guidance in encoder software and/or department coding policies and procedures.
• Using encoder, reviews Ambulatory Payment Classifications (APC) and Enhanced Ambulatory Patient Groups (EAPG) assignments.
• Reviews Local Coverage Determination (LCD) edits and guidance for codes meeting medical necessity.
• Researches medical record for any additional diagnoses documented to meet medical necessity.
• Reviews and validates the accuracy of data in the Admission, Discharge Transfer (ADT) fields following HIM coding procedures and processes.
• Reviews medical record documentation to determine all appropriate diagnosis (including HCC Coding Hierarchical Condition Category), procedural and modifier code assignments.
• For hospital coding, reviews medical record documentation (i.e., provider orders); may code outpatient diagnostic and therapeutic encounters requiring minimal procedural coding.
• For physician billing, collaborates with billing department to ensure all bills are satisfied.
• For hospital, routes to billing charge entry errors and/or account edits preventing completion of coding and/or billing.
• Makes appropriate coding corrections, when advised, and follows procedure to notify billing.
• Enhances and maintains coding knowledge and skills.
• Reviews all appropriate work queues daily to address edits and makes corrections following procedures and processes.
• Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding.
• Submits daily productivity report to HIM manager by defined deadline.
• Meets and maintains HIM coding quality and productivity standards.
• Attends internal and external educational meetings and seminars to maintain certification and continuing education requirements.

Qualifications

• High School Diploma or Equivalent (Required)
• Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA)
• Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA)
• Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA)
• Registered Health Information Technician (RHIT) - State of Florida (FL)
• Registered Health Information Technician (RHIT AHIMA) - American Health Information Management Association (AHIMA)

Requirements

• For HIM coder, one (1) year hospital-based outpatient coding experience.
• For Physician Billing Coder, one (1) year diagnostic/procedural office coding experience with surgical coding experience or six (6) months working within the Memorial Health System.
• Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS) or Certified Coding Associate (CCA).
• For Physician Billing: Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Certified Risk Adjustment Coder (CRC) by AAPC, or Certified Coding Specialist (CCS), Certified Coding Specialist - Physician Based (CCSP) by AHIMA.
• For Hospital Billing: Certified Coding Specialist (CCS), Certified Coding Associate (CCA) or Certified Professional Coder (CPC).

Company Description