Pace Medical Coder
The PACE Medical Coder will review clinical documentation and diagnostic results as necessary to verify the appropriate assignment of the ICD-10 CM, CPT and HCPCS codes as per Official Guidelines for Coding and Reporting.
This position is intended to be a hybrid role, where the incumbent will be expected to primarily work remotely. There is a minimum monthly on-site requirement; additional on-site presence may be required based on business need.
Essential Functions of the Job:
- Reviews the Chart Progress Notes, patient documentation for diagnoses, procedures, and services performed by physicians and other qualified healthcare providers.
- Determines all HCC codes associated with patient encounters.
- Keeps up to date with the latest CMS risk adjustment guidelines.
- Verifies all diagnostic procedural codes from the electronic health record using ICD-10 CPT and HCPCS coding classifications.
- Communicates effectively with providers concerning documentation to assure proper coding and reimbursement.
- Identifies all chargeable items within each progress note to ensure proper CPT/HCPCS codes for each of the items.
- Applies sequencing guidelines for the diagnosis codes and selection of the principal diagnosis and procedure according to ICD-10 guidelines
- Tracks open/close encounter reports to assure that all patients seen in the clinic are properly coded.
- Organizes & prioritizes all work to ensure that records are coded in time frames that will be in line with department policies.
- Maintains knowledge of Anatomy & Physiology to interpret general medical classifications for coding including the most complicated encounters/cases.
- Acts as an expert resource person to other coders & personnel in other departments regarding coding questions & issues.
- Participates in ongoing education, including in-service training and other activities to maintain and improve competence.
- Adheres to SYHC's Core Competencies and professional Code of Conduct Behavior Standards in their day-to-day work by consistently demonstrating the Core Values of Respect, Excellence, Integrity and Empowerment.
- Performs any other related job duties as assigned and/or requested
Additional Duties and Responsibilities:
- Adheres to all applicable SYHC's Policies, Procedures and processes
- Demonstrates skills in collaboration with team and problem-solving
- Excellent written and oral communication skills
- Enhances professional growth and development through participation in educational programs, current literature, in-service meetings and workshops
- Attends meetings as required and participates on committees as directed
- Demonstrates courtesy and treats every patient and employee with dignity in every interaction
- Assists in the maintenance and/or revision of established Departmental Policies and Procedures
- Maintains confidentiality of all patient electronic medical records
- Maintains a clean, safe, and organized work area at all times
- Performs all other related duties as assigned or requested
Job Requirements:
Experience Required:
- Zero (0) to One (1) year of medical coding experience required with CPC-A certification
- One (1) year of medical coding experience required with a CPC/CRC or CCS
Education Required:
- High School Diploma or GED Equivalent
Certifications Required:
- Certified Professional Coder (CPC; CPC-A may be considered) or Certified Risk Adjustment Coder (CRC) from the American Academy of Professional Coders (AAPC); or Certified Coding Specialist (CCS) from the American Health Information Management Association certification required
Verbal and Written Skills Required to Perform the Job:
- Good oral and written communication skills
- Good customer service skills
Technical Knowledge and Skills Required to Perform the Job:
- Extensive knowledge of medical terminology, human anatomy and physiology
- Knowledge of diagnostic tests, procedures, pathology terms and drug reference books. Knowledge of ICD-10-CM and HCPCS/CPT, HCC coding & abstracting procedures
- Proficient in typing skills and experience with using computers and software systems
Equipment Used:
- General office equipment to include PC and Software (Excel, Word, Office), phone, fax, etc.
Working Conditions and Physical Requirements:
- This position is intended to be a hybrid role, where the incumbent will be expected to primarily work remotely. There is a minimum monthly on-site requirement; additional on-site presence may be required based on business need
- Long Irregular hours; may work weekends
- Prolonged periods of sitting, and constant walking and standing
- Driving and occasional travel required
Universal Requirements:
Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs. Compliance with all mandated vaccinations and all boosters is a term and condition of employment.