Position Title: Clinic Coder I

Department: Clinic Billing

Reports To: Director of Clinic Systems

Direct Reports: None

FLSA Classification: Non-Exempt

Position Summary

The Clinic Coder I is responsible for conversion of diagnosis and treatment procedures into codes utilizing the current Revision of the International Classification of Diseases and Operations, Clinical Modification (ICD-10-CM), Current Procedural Terminology (CPT-4), Evaluation and Management (E&M), and HCPCS coding for Professional (Physician) services received in the CMH Health Services system. Requires skill in the sequencing of diagnosis/procedures to optimize reimbursement and compliance to documentation and medical policy guidelines for all payers. Ensures that records are coded in an accurate and timely manner. Performs audits on chart information, level of care charged and provides education to staff and providers on compliant coding.

General Duties, Tasks and Responsibilities

• Selects appropriate codes for reimbursement purposes; enters non-office charges into system as needed; investigates and solves all claims questions releasing the claim for submission.
• Utilizes computerized coding/abstracting software, coding references and resources, and medical dictionaries to ensure the most accurate and efficient entry of information.
• Codes all diagnoses/procedures in accordance to ICD-10-CM, CPT, and HCPCS coding principles and the Coding Manual; ensures data quality and optimum reimbursement allowable under the federal and state payment systems.
• Performs coding audits on medical charts as assigned.
• Provides one-on-one provider education about documentation and coding requirements.
• Provides staff education and assists providers with utilization of EMR for timely and compliant documentation as needed.
• Reconciles charges against reports to ensure charges are captured appropriately.
• Understand medical/legal implication of incorrect coding and documentation of patient medical records.
• Runs weekly deficiency reports to keep track of physician documentation deficiencies.
• Reviews and corrects coding denials on claims as assigned.
• Complies with all established safety procedures to ensure a safe environment for patients, visitors and staff.
• Participates in performance improvement activities.
• Performs other duties as assigned.

Education Requirements

Certification/Licensure Requirements

Experience Requirements

Computer Skills

Additional Skills

• Ability to work independently, prioritize and complete tasks in a timely manner
• Knowledge of diagnoses/procedures in accordance with ICD-10-CM, CPT and HCPCS coding principles
• Knowledge of medical terminology, anatomy and physiology