The Certified Coder is responsible for the timely and accurate coding of administrative and clinical data through the assignment of ICD-10-CM, ICD-10-PCS, and/or CPT codes. This position ensures compliance with all federal regulations, state licensing requirements, and the policies and procedures of Three Crosses Regional Hospital.
The incumbent will carry-out duties by adhering to the highest standards of ethical and moral conduct, acts in the best interest of Three Crosses Regional Hospital, and fully supports the mission, vision, and values of 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
Education and Experience:
Required: High School Diploma or equivalent
Preferred: 3+ years medical coding experience
Required : Meet all Employee Health Requirement
License/Certification(s)
Required : One certification from CCA, CPC, CPB, CCS, CIC, COC, CCS-P accredited from AAPC or AHIMA
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