The Certified Coder is responsible for working with clients to achieve ongoing Revenue Cycle Performance/Management, customer reporting and satisfaction. The Coder is responsible for accurate coding of all visits and surgeries, acting as a resource to the client as well as the accounts receivable team for coding related denials.
- CPC Certification through AAPC or AHIMA, Required
- In depth knowledge of clinical workflow
- Expert in Microsoft Office products, including Word and Excel
- Must have the ability to do production level coding
- 3 Years specialty specific coding experience
- Training experience preferred
- Expert experience with CCI edits
- Revenue Cycle Management (RCM) experience required
- Denial management and appeals experience, preferred
- Strong verbal and written communication skills
- Ability to pass medical coding assessment
- COSP preferred
- Perform medical record review with the purpose of coding CPT and ICD level coding
- Trains providers and/or coding staff on the usage of platforms for charge capture purposes
- Works with the Education Supervisor on system updates and creates/coordinates ongoing training to providers and staff as required
- Assists as needed with the creation of ICD-10 CM, CPT/HCPCS coding rules and pick lists for providers
- Responsible for initial and ongoing education of all care providers on key revenue cycle topics, including but not limited to ICD-10 CM, CPT/HCPCS and E/M coding, documentation, billing policies and regulatory compliance
- Ensures the accuracy of documentation is maintained through the analysis of coded data
- Provides re-education and training of providers if accuracy of the documentation is not maintained. Analyzes and trends data to identify areas of opportunity related to documentation and coding.
- Educates providers regarding correct documentation per CMS guidelines to ensure the organization is billing appropriately
- Conducts concurrent coding reviews for newly hired providers and coding staff
- Provides timely feedback to management
- Assists with the development of training and educational materials as needed to address documentation and coding deficiencies.
- Coordinates schedules and conducts new hire education and training.
- Interacts closely with the providers in education for documentation or coding purposes due to conflicting documentation, clarification of documentation through query process.
- Reviews platform upgrades and creates revised departmental documentation when necessary
- Reports system issues as they relate to coding functions and assists with resolving complexities in training workflow
- Stays current on coding updates and communicates changes to providers and coders in a timely manner
- Works closely with management to identify denials and develops education that will minimize future claim rejections as they pertain to medical necessity and coding errors
- Understands and applies Medicare billing rules (i.e., LCD/NCD/CCI)
- Advanced Proficiency with MS-Excel, Word, and PowerPoint
- Account for internal control responsibilities in line with the organization’s objectives
- Ability to handle Protected Health Information in a manner consistent with the Health Insurance Portability and Accountability Act (HIPAA)
- Perform other Account management duties as requested or assigned