Position Summary:
The Certified Medical Coder will play a crucial role in accurately coding and abstracting medical records for billing and reimbursement purposes. The Certified Medical Coder will be responsible for reviewing physician/non-physician documentation, accurately assigning CPT, ICD-10-CM and HCPCS Level II codes, and ensuring compliance with coding guidelines and regulations. Attention to detail, time management, and a high-level of customer service skills are required. We are looking for a positive team player with a strong work ethic and good attendance history. This full-time position reports to the Vice President-Claims Administration.
Position Qualifications:
- Current Certification as a Certified Professional Coder (CPC*) form AAPC.
- 5+ years of coding experience preferred in Behavorial Health, Medication-Assited Treatment (MAT), and internal medicine settings.
- Medicaid/Medi-Cal experience preferred.
- High level of customer service skills is required.
- Strong understanding of anatomy, physiology, and medical terminology required.
- Ability to work independently and in a team environment.
- Effective communication skills: both written and verbal.
- Detail-oriented with high accuracy in coding and data entry.
- Ability to maintain benchmarks such as production and low error rate.
- AHIMA, RHIT, specialty coding certifications a plus.
Responsibilities:
- Review and analyze medical records to identify and extract relevant diagnoses, procedures and services for accurate coding.
- Assign appropriate diagnosis codes (ICD-10-CM) and procedure codes (CPT/HCPCS) based upon medical documentation.
- Verify and ensure that all codes are accurately applied and comply with coding guidelines and regulations.
- Review and resolve coding-related denials, discrepancies, and inquiries.
- Assist physician/providers with questions regarding coding and documentation guidelines.
- Provides ongoing feedback based on observations form coding physician/provider documentation.
- Identifies opportunities for education and communicates trends to lead.
- Review and resolve charge sessions that fail charge review edits, claim edits, and follow-up denials.
- Work to improve billing based on findings/resolution of errors.
- Manage assigned charge reviews, claim edits, and coding follow-up work queues.
- Monitors charges and codes for appropriateness of modifiers in relation to NCCI/CCI edits and payer specific requirements.
- Stay updated with the latest coding guidelines, regulations, and industry changes.
- Maintain confidentiality and always adhere to HIPPA regulations.
- Perform other duties and projects as assigned.
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