Job Description

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.