Summary of Role

Individuals will be responsible for coding all physician, clinical, and surgical claims. Review documentation via EHR or operative note to verify the accuracy and completeness of CPT and ICD10 code assignment for claims submission. The Medical Coder is responsible for translating medical documentation into standardized codes that accurately represent the patient's medical history, treatments, and procedures. The role ensures that the hospital’s billing processes are precise and compliant with regulations, facilitating efficient reimbursement from insurance companies and payers.

Key Responsibilities

• Serves as the key point of contact for coding information
• Provides onsite coding and documentation, education, and feedback to providers for coding changes (CPT including E&M, modifiers and internal codes, ICD-9, ICD-10, HCPCS), annual updates, payor requirements, and insurance rejection resolution
• Staying abreast of payer regulations and documentation requirements. Stay updated with coding guidelines, payer policies, and regulatory changes.
• Procedure precertification assigning of ICD-10 and CPT codes.
• Maintains current knowledge of Medicare, Medicaid, and other regulatory requirements of nationally accepted coding policies and standards. Ensure coding practices adhere to legal and ethical standards, including HIPAA regulations.
• Coding in-office E&M services, procedures, and surgeries. Assign appropriate ICD-10, CPT, and HCPCS codes to diagnoses, procedures, and services.
• Review and analyze patient medical records and documentation from physicians.
• Ensure accuracy and completeness of coded data for statistical and reimbursement purposes.

Qualifications

• High School Diploma or equivalent
• Minimally 3 years of coding experience, preferably in orthopedics
• Certification from either the American Academy of Professional Coders (CPC) or the American Health Information Management Association (AAPC)
• Advanced knowledge of ICD, CPT, and HCPCS coding guidelines
• Advanced knowledge of medical terminology, anatomy and physiology, and regulatory requirements
• Ability to develop rapport and maintain positive, professional relationships with physicians
• Excellent critical thinking and analytical skills, with a high attention to detail
• Ability to work independently and exercise independent judgment and decision-making
• Ability to meet deadlines while working in a fast-paced environment
• Strong computer skills including knowledge of Microsoft Office
• EPIC experience preferred

Physical and Mental Demands

Communication Skills

Effective written and verbal communication skills for interacting with healthcare providers and team members. Ability to explain coding requirements and documentation needs clearly. Communicate effectively with the billing department to resolve coding discrepancies. Provide feedback and education to staff on documentation requirements.

Mathematical Skills

Perform basic arithmetic to accurately calculate charges, payments, adjustments, and balances. Analyze numerical data for error rates, claim denials, and trends. Assist in budgeting, provide cost projections, and reconcile financial records. Calculate patient charges, insurance reimbursements, and out-of-pocket expenses, understanding insurance policies for accurate billing.

Judgement and Decision Making

Make informed decisions regarding code assignments and documentation improvements. Evaluate the completeness and accuracy of medical records and recommend necessary changes. Uphold strict confidentiality standards to protect patient information and comply with HIPAA regulations.

Software and Technology

Proficiency in ICD-10, CPT and HCPS coding. Advanced knowledge of Microsoft Office with an emphasis on Microsoft Excel. Experience using and working with EPIC systems.

Work Environment

Ability to sit for extended periods. Manual dexterity for typing and using coding software. Visual acuity to read medical records and computer screens. The primary work environment is office-based. The noise level in the work environment is usually moderate. Occasional remote work may be possible based on hospital policies and needs.