CLINIC CODER in Macomb, Illinois at McDonough District Hospital

Reviews, analyzes, codes, and abstracts physician services and clinic-based professional fee encounters to ensure accurate assignment of diagnoses, procedures, and services in accordance with current coding guidelines, documentation requirements, and applicable payer policies. Assigns ICD-10-CM diagnosis codes, CPT procedure codes, and HCPCS Level II codes, as applicable, to support accurate billing, reimbursement, regulatory compliance, and quality reporting.

Reviews medical record documentation for completeness, consistency, and coding accuracy; identifies documentation deficiencies, coding discrepancies, and potential compliance concerns; and communicates with providers and appropriate staff to obtain clarification when needed. Utilizes coding references, encoder software, and other available resources to research and resolve coding questions. Maintains established coding accuracy and productivity standards and supports continuous improvement in coding quality and revenue cycle performance.

• High school diploma or equivalent required.
• Current coding certification through AAPC or AHIMA required. Acceptable credentials may include Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Coding Specialist–Physician-based (CCS-P), or another approved coding credential appropriate to the position.
• Minimum of 2–3 years of professional medical coding experience preferred; demonstrated experience coding physician office or ambulatory professional fee services is strongly preferred.
• Experience with multiple clinic specialties, particularly primary care, OB/GYN, pediatrics, general surgery, gastroenterology, orthopedics, and wound care, is preferred.
• Previous medical billing, claims review, or revenue cycle experience is a plus.
• Experience with electronic health records, encoder software, and computerized coding resources is preferred.

Job Knowledge

• ICD-10-CM Coding: Knowledge of diagnosis coding conventions, sequencing requirements, official guidelines, and applicable annual code updates.
• CPT Coding: Knowledge of professional fee coding for evaluation and management services, procedures, and other physician services.
• HCPCS Level II Coding: Knowledge of applicable codes for supplies, services, and other items not fully represented by CPT.
• Documentation Review: Ability to analyze medical record documentation, identify relevant clinical information, recognize documentation deficiencies, and determine appropriate code assignment based on the record.
• Specialty Coding: Knowledge of coding requirements and documentation practices applicable to primary care, OB/GYN, pediatrics, surgery, gastroenterology, orthopedics, wound care, and other assigned specialties.
• Coding Compliance: Knowledge of official coding guidelines, applicable payer policies, medical necessity requirements, and regulatory standards affecting professional fee coding.
• Evaluation and Management Coding: Knowledge of applicable E/M coding guidelines, including medical decision-making, time-based coding when appropriate, and documentation requirements.
• Coding Resources and Technology: Proficiency in using electronic health records, encoder software, coding references, and online resources to research code selection and resolve coding questions.
• Revenue Cycle Fundamentals: Understanding of the relationship between accurate coding, claim submission, reimbursement, medical necessity, denials, and compliance.
• Medical Terminology and Anatomy: Working knowledge of medical terminology, anatomy, physiology, and common disease processes sufficient to interpret provider documentation and assign appropriate codes.

Abilities, Interests, and Temperaments

• Accuracy and Attention to Detail: Demonstrates a high level of accuracy and attention to detail when reviewing medical records, interpreting documentation, assigning codes, and entering coding information. Expected to achieve and maintain the established coding accuracy standard of 95% or higher.
• Problem-Solving and Analytical Thinking: Ability to analyze complex or incomplete documentation, recognize inconsistencies and discrepancies, research coding questions, evaluate available information, and determine appropriate next steps within established guidelines.
• Coding Judgment: Ability to apply coding guidelines consistently, exercise sound professional judgment, recognize when clarification is needed, and escalate unresolved questions or potential compliance concerns appropriately.
• Productivity and Time Management: Ability to organize and prioritize assigned work, manage competing deadlines, and meet established productivity targets without compromising coding accuracy or quality.
• Organization and Adaptability: Ability to work independently in a structured environment while adapting to changes in coding guidelines, payer requirements, technology, assigned specialties, and workload.
• Communication and Interpersonal Skills: Ability to communicate clearly, professionally, and tactfully with providers, clinic staff, billing personnel, and other members of the revenue cycle team to resolve coding questions and documentation issues.
• Research and Resource Utilization: Ability to locate, interpret, and apply authoritative coding guidance and appropriate reference materials to resolve coding questions and maintain current knowledge.
• Computer and Data Skills: Ability to navigate electronic health records, encoder software, computerized coding systems, and other applications efficiently. Demonstrates the ability to interpret and manipulate data as needed to perform coding duties.
• Confidentiality and Professionalism: Ability to maintain confidentiality, exercise discretion, and handle protected health information in accordance with organizational policies and applicable regulations.
• Independent Work and Accountability: Ability to work with minimal supervision, accept responsibility for coding decisions and performance, respond constructively to quality feedback, and participate in ongoing education and performance improvement.
• Continuous Learning: Demonstrates a commitment to maintaining coding certification, staying current with annual code and guideline changes, and developing knowledge of assigned specialties and evolving reimbursement requirements.