Certified Medical Coder (P3)
Job Title: Certified Medical Coder (P3)
Reports To: Revenue Cycle Director (RCD) or Physician Coder
Job Summary: Reviews and ensures accuracy of medical coding for all services rendered by assigned providers including appropriate diagnostic documentation of risk and chronic conditions through a master understanding of specific ICD -10 codes and CPT II codes.
Qualifications and Requirements:
To perform this job successfully, an individual must be able to perform each essential job duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.
Essential Job Duties:
- Assigns and sequences appropriate diagnostic/procedure billing codes, in compliance with third party payer requirements.
- Acts as a coding claims review specialist.
- Provides appropriate training and education to staff on current and future coding guidelines based on industry trends and best practices.
- Researches and completes coding projects as assigned.
- Reviews and modifies, if necessary, CPT, HCPCS and ICD-10 codes from assigned provider visit notes in a timely fashion, ensuring all supported codes are captured on the claim form(s) and submits to the health plan; closing both HCC and HEDIS/Stars care gaps.
- Establishes themselves as the expert in CPT II and ICD-10 coding, and the relationship between specific coding practices and medical risk stratification.
- Participates in other coding/billing assignments when there is downtime from P3 patients’ assignments.
- Queries the provider for clarification, as needed using communication guidelines provided by the RCD/Physician Coder.
- Identifies providers who may need additional educational training about their documentation and/or code selection.
- Coding quality is at 95% accuracy or greater.
- Collaborates with RCD/Physician Coder regarding planned provider coding education sessions.
- Participates regularly required in CCHCI training, personal performance, and staff meetings.
- Assists in addressing unbilled/unsubmitted encounters.
Required Education, Experience, Certificates & Licenses:
- High School Diploma or GED.
- Current professional coding certification required through AAPC or AHIMA.
- Any combination of experience and/or education that provides the necessary combination of skills.
- Documented Participation in training and education programs to maintain professional competence and skills applies.
Preferred Education, Experience, Certifications & Licenses:
- One year experience in medical billing preferred.
Required Language Skills:
- Ability to comprehend and compose effective instructions, correspondence and communications in English in both oral and written format.
- Physical Requirements:
- Ability to occasionally exert enough force to move objects weighing up to 10 pounds.
- Ability to continuously remain in a stationary position.
- Ability to occasionally move about inside the workplace to access files, office machinery, etc.
- Possesses hand-eye coordination and manual dexterity necessary to constantly operate computer, telephone, and other office machinery.
- Possesses close visual acuity necessary to accurately record and view information on a computer monitor, handwritten and typed documents.
- Ability to discern the nature of sounds at a normal spoken volume.
Other Required Knowledge, Skills, and Abilities:
- Ability to add, subtract, multiply and divide in all measure, using whole numbers, common fractions and decimals.
- Ability to compute rate, ratio and percent.
- Ability to skillfully gather and analyze data.
- Ability to perform variety of assignments requiring independent judgment.
- Ability to deal with challenges involving one or more variables in routine situations.
- Knowledge of billing, medical records, health plans, and community health centers preferred.
- Advanced, specialized knowledge of medical codes and coding procedures.
- Thorough knowledge of ICD, CPT, and NDC codes.
- Knowledge of HIPAA and Corporate Compliance rules and regulations.
- Computer literacy required with proficiency in Microsoft Excel.
- Knowledge of Electronic Health Records and Practice Management software preferred.
Work Environment & Conditions:
- Work environment is usually typical of an administrative office setting with no substantial exposure to adverse environmental conditions.
- Work may be regularly performed remotely as assigned and may include extended hours including early mornings, evenings, and weekends.
Job Status: Full Time