Coder, ProFee

Job summary

Assigns ICD-10-CM and CPT/HCPCS codes for various specialty service accounts and abstracts key data for billing and regulatory agencies. Collaborates with providers to clarify documentation and resolves claim edits to ensure compliant billing.

Job details

Duties and Responsibilities: Assigns ICD-10-CM codes, and CPT/HCPCS codes for various specialty service accounts, including but not limited to diagnoses, provider level evaluation & management (E/M) charges, and additional CPT-4 procedures. Abstracts key data elements required for billing, regulatory agencies, and other databases. Reviews records for clinical pertinence and documentation to support accurate facility and provider-based charges for services performed during the encounter. Communicates with providers for clarification of documentation to ensure appropriate assignment of diagnoses, procedures, and/or facility and provider evaluation/management (E/M) levels. Reviews and resolves claim edits related to emergency department encounters to ensure compliant billing, including but not limited to medical necessity and NCCI/CCI edits. Assists with resolution of simple visit coding errors related to other outpatient visits as needed. Demonstrates courtesy and professionalism through interaction, appearance, attitude, and written and oral communications with visitors, co-workers, physicians, and other hospital personnel as to represent the Medical Records Services as a high-quality service area of the Hospitals. Maintains patient confidentiality as required by Hospitals/departmental policy and industry/legal standards. Acknowledges and supports Hospitals defined goals and approach to patient care; attends regular training sessions to improve patient and customer communications. Knowledge, Skills, and Abilities: Skill in prioritizing and performing a variety of duties within a system that has frequently changing assignments, priorities, and deadlines. Ability to impart knowledge of procedures and techniques. Thorough working knowledge of ICD-10-CM and CPT coding systems, and federal/state regulations regarding reimbursement. Thorough working knowledge of the hospital information system, electronic medical record systems, and encoder. Working knowledge of standards for chart completion. Maintains Continuing Education credits in accordance with the American Health Information Management Association's and/or American Academy of Professional Coders’ requirements based upon certification(s). Performs qualitative analysis of records in accordance with regulatory standards and coding requirements using CPT/HCPCS and ICD-10-CM guidelines. Working knowledge of medical-legal rules and regulations that govern the confidentiality and release of medical information with the ability to interpret and implement the standards. Must maintain total confidentiality of all patient records. Must be comfortable working with AR teams to resolve issues. Must be able to pass a coding assessment. Must be proficient in Microsoft Office, including Outlook, Excel, and Teams. Ability to multi-task and have excellent communication skills. Must meet and maintain a 95% quality accuracy rate and productivity standards. Must have experience working in a remote environment.

What you’ll do

Assigns ICD-10-CM and CPT/HCPCS codes for various specialty service accounts and abstracts key data for billing and regulatory agencies. Collaborates with providers to clarify documentation and resolves claim edits to ensure compliant billing.

Requirements

Requires thorough knowledge of ICD-10-CM, CPT coding systems, and federal/state reimbursement regulations. Candidates must be proficient in Microsoft Office, pass a coding assessment, and maintain a 95% quality accuracy rate.

Listed skills

• Microsoft Office · Preferred

Other relevant skills

Identified from the job description. Confirm important requirements above.

• ICD-10-CM Coding
• CPT/HCPCS Coding
• Medical Billing
• Electronic Medical Records
• Medical Necessity Review
• NCCI/CCI Edits
• Microsoft Office
• Patient Confidentiality
• Clinical Documentation Improvement
• Qualitative Analysis

Job areas

• Healthcare
• Administrative
• Data & Analytics