Coder, Certified Professional - FT Days in Las Cruces, New Mexico at Three Crosses Regional Hospital

Primary Responsibilities

• Independently perform analysis of claims on a pre- and post-payment basis utilizing clinical, coding and claims  Independently analyze claims on both a pre- and post-payment basis, utilizing clinical, coding, and claims processing knowledge to ensure accuracy in accordance with CPT, ICD-10, and risk adjustment guidelines
• Review medical records to validate or invalidate potential coding and billing issues identified on claims
• Develop and maintain an individual audit schedule in coordination with leadership and providers
• Thoroughly document findings to support claim adjustments, including supporting medical records and coding rationale
• Identify and document process gaps contributing to incorrect payments
• Ensure the security and confidentiality of all protected health information (PHI) accessed during work activities
• Apply clinical and coding expertise to ensure accurate and complete documentation for coding and claim submission
• Report missing charges and reconciling discrepancies prior to claim submission
• Identify opportunities to educate providers, staff, and colleagues on documentation and coding best practices
• Meet established productivity, accuracy, timeliness, and documentation standards
• Collaborate with clinical staff and the Director of Revenue Cycle to resolve coding queries and support claim progression through the revenue cycle
• Adapt to new systems, technologies, and coding updates with flexibility and efficiency
• Attend staff meetings as required
• Other duties as assigned.

Knowledge, Skills and Abilities

• Demonstrate critical thinking, time management and problem-solving skills
• Excellent verbal and written communication (including documentation) skills
• Ability to organize and prioritize tasks
• Experience with electronic medical records system
• Experience with medical record documentation, medical chart auditing/quality experience
• Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology