Coder I

About this role

Default Work Shift:

Day (United States of America)

Hours:

40

Salary range:

$23.97 - $36.42

Schedule:

Full Time

Shift Hours:

8 Hour employee

Department:

Clinic Billing Services

Job Objective:

Reviews E&M and simple visit charges submitted by providers in assigned work queue(s) to validate level of service, place of service, new verses established, and modifier review to ensure valid creation of claim. Reviews and enters manual charges submitted by providers for external services. Reviews and resolves simple NCCI, LCD and MUE edits.

Job Description:

Education:

Required: High school diploma, GED or higher level degree

Preferred: Enrolled in a coding certification program or holding an Apprentice Certificate in coding- CPC or CCS; courses in Medical Terminology, Anatomy and Physiology

Licensure/Certification:

Required: CPC-A, CPC, CSC or RHIT Coding Certification within eighteen (18) months of hire

Experience:

Required: One (1) year of experience in billing/charge capture coding or related services

Reports To: Manager-Coding and Charge Capture

Supervises: N/A

Ages of Patients: N/A

Blood Borne Pathogens: Minimal/ No Potential

Skills, Knowledge, Abilities:

Ability to use Microsoft Office Suite (Word, Excel, Outlook, PowerPoint) and other relevant software applications, Coding software familiarity, Knowledge of Denial and appeals process, Knowledge of general CMS guidelines and general billing guidelines, Knowledge of ICD-10-CM & CPT/HCPCS coding conventions, Knowledge of medical terminology, anatomy and physiology, Written and verbal communication skills

Essential Responsibilities

• Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations.
• Maintains quality of work based on current published standards.
• Reviews documentation and sequences diagnoses and procedures using current coding guidelines for E&M and simple visit encounters.
• Completes claim information and validates for split or non-split payers.
• Communicates with Coder IIs, department management and clinic staff to obtain needed documentation to ensure correct billing.
• Completes assigned work queue assignments within departmental productivity standards.
• Obtains and maintains a 95% accuracy rate.
• Maintains a thorough understanding of anatomy and physiology, medical terminology, disease processes through participation in continuing education programs to effectively apply ICD-10-CM and CPT-4 coding guidelines to inpatient and outpatient simple visit encounters.
• Performs other duties as assigned.