Coder, Medical

Summary of Position

* Serve as the subject matter expert on CPT (Current Procedural Terminology) and ICD-10 (International Classification of
Diseases) coding guidelines.
* Oversee the proper use of procedure and diagnosis coding to ensure CMS (Centers for Medicare & Medicaid Services) and
insurance guidelines are met and to obtain optimal claims reimbursement.
* Review, interpret and resolve complex medical coding issues requiring coder interpretation including review of claim edit
queues that cannot be resolved by external billing vendor.

Principal Accountabilities

* Review and resolve coding related edits generated in the EMR (Electronic Medical Record) requiring coding
interpretation to ensure accurate/ appropriate level of coding, timely billing and payment of medical claims.
* Assign accurate medical diagnosis and procedure codes across a wide range of services, which include evaluation and
management of anesthesia, surgical services, radiology, and other medical codes.
* Conduct coding review on provider documentation to ensure assignment of the correct ICD-10 codes and ensure
documentation is accurate, precise, and adherent to CMS guidelines.
* Perform charge audits through review of chart notes and assign correct procedure and diagnosis codes. Audits may
include peer review and Medicare charges with significant diagnosis codes.
* Maintain proficiency in all specialty coding guidelines.
* Assess performance of code review functions including optimal use of staff and systems.
* Read and interpret provider operative notes and code surgeries or procedures with appropriate CPT and ICD-10 codes
based upon the written documentation.
* Research, review, and analyze new medical procedures and corresponding CPT/HCPCS (Healthcare Common
Procedure Coding System) codes; gather input from providers.
* Recommend CPT or HCPCS codes consistent with state and federal policies.
* Review billing and EMR system to identify and analyze trends;
* Identify actual or potential issues; recommend and implement corrective actions.
* Maintain up-to-date knowledge of AMA (American Medical Association) Coding guidelines and assignment of ICD-10-
CM codes including impact and implications to healthcare providers.
* Maintain up-to-date knowledge of national coding guidelines.
* Research and maintain the collection of industry standards.
* Maintain regular and on-going communication with management and medical staff to resolve coding and associated
issues.
* Research and maintain current Medicare reimbursement policies.
* Research industry standards related to reimbursement policies.
* Collaborate with external billing company coding team to identify, troubleshoot and resolve coding related issues.
* Update physicians and managers on regulatory and coding system changes, review training needs and create and
implement training plans as needed.
* Perform other-related duties as directed, assigned or required.