Certified Professional Coder, PAM

Medical Records Reviewer

This position is responsible for reviewing a patient's medical records after a Clinic visit and translating the information into codes that insurers use to process claims for patients. Duties include confirming treatments with medical staff, identifying missing information, and submitting information to insurers for reimbursement.

Responsibilities (Essential Functions):

• Accurately assigns and sequences codes (ICD-10-CM, CPT, HCPCS/modifiers as necessary) for each patient encounter, following proper coding guidelines and legal requirements to ensure compliance with federal and state regulations.
• Ensures professional/physician billing CPT codes/ICD-10 codes are assigned correctly and sequenced appropriately as per government and insurance regulations.
• Queries providers or other Clinic team members when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes.
• Assigns and enters charges such as evaluation and management (E&M) levels, infusion/injections, observation hours, etc.
• Participate in continuing education activities to expand coding skills and stay abreast of changes in coding guidelines and reimbursement reporting requirements.
• Identifies and reports discrepancies, potential quality concerns, and billing issues.
• Reviews records to ensure documentation in the record supports ordered services and meets medical necessity.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Association and adheres to official coding guidelines.
• Distributes confidential and sensitive information or documentation; handles highly confidential records. Ensures records are safe and secure at all times.
• Regular attendance and punctuality for scheduled shifts.
• Maintains professional and technical knowledge through continuing education opportunities including internal and external educational offerings.
• Utilization of assistive devices for lifting is mandatory.
• Must adhere to safety protocols at all times.
• Per DRH policy, all required conditions of employment must be met and maintained including required vaccinations.
• Implement DRH Standards of Behavior and exhibit behaviors consistent with DRH core values.
• Performs other related duties as assigned.

Qualifications

Job Requirements:

Minimum Qualifications: Communication and interpersonal skills including fluency in oral and written English. Basic computer skills including the ability to send/receive/email, navigate information technology associated with the position, and use Electronic Health Record information tools. Strong attention to detail with excellent organizational skills. Ability to adapt procedures, processes, tools, equipment, and techniques to accomplish the requirements of the position.

Education and/or Experience: High school diploma or equivalent required. At least 2 years of progressively responsible experience in medical insurance, medical billing, or medical reimbursement preferred.

Proven knowledge of CPT and ICD-10 coverage policies, coding guidelines, internal revenue cycle coding processes, and billing practices of the specialty service line. Demonstrated ability to read and interpret E&M notes, complex diagnostic study results, endoscopic, interventional and/or procedure operative notes. Based on documentation review, demonstrated ability to confirm or change the billed CPT code(s), diagnosis code(s) and modifiers (if applicable) in order to attain clean claim result. Strong knowledge of the carrier coverage policies and documentation requirements for specialty specific service lines. Ability to work independently and remain flexible to quickly adapt to urgent situation.

Certifications, Licenses, Registrations: Certified Professional Coder (CPC), Certified Medical Coder (CMC), Certified Coding Specialist (CCS), Certified Coding Associate (CCA), or Certified Professional Auditor (CMPA) or equivalent required; May have up to 6 months to obtain after date of hire or transfer. For those positions requiring travel, a current valid driver's license and automobile liability insurance must be maintained.