Memorial Healthcare provides high-quality, personalized health options to meet the evolving needs of the community it serves. The organization provides a wide range of comprehensiv
Coder I - MPG - FT - Days - MSS - Remote Eligible
Location
United States
Posted
25 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
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
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