Position Summary:

The Medical Coder demonstrates proficiency in all aspects of outpatient coding. Performs ongoing coding of claims to ensure accuracy of coding and billing and sufficiency of supporting documentation. This position can be fulfilled with remote working. The employee may elect to work from the corporate office in Greenville, SC if that is preferable to remote working.

Essential Duties and Responsibilities include the following and other duties that are assigned.

• Assign ICD-10-CM and CPT/HCPCS codes with modifiers for services provided in the facility (Professional fee coding).
• Review all applicable documentation of various providers to determine the appropriate codes to assign for all medical services, procedures, and diagnoses from available documentation within electronic medical records.
• Ensures diagnosis codes meet local and national medical necessity guidelines.
• Be knowledgeable of billing and coding requirements for governmental and private insurance payers.
• Utilize coding resources along with any other applicable reference material available to ensure accuracy in coding for all assigned services.
• Demonstrates the technical competence to use the facility encoder and EMR in an office or remote setting.
• Review and resolves coding edits and denials. Assists with rebilling accounts when necessary.
• Maintain a working knowledge of various laws, regulations and industry guidance that impact compliant coding.
• Follow all HIPAA regulations and uphold a higher standard around privacy requirements.
• Completes all assigned work in a timely manner based on internal and/or payer standards.
• Must meet all coder productivity and quality goals; Maintain a 95% accuracy rate.
• Attending and reporting at weekly team calls with Director of Medical Coding Compliance.
• Reporting coding patterns identified within the coding process to management.
• Responsible for maintaining current knowledge of coding guidelines and relevant federal regulations through the use of current CPT-4, HCPCS II, and ICD-10 materials, the Federal Register, and other pertinent materials.
• Adhere to all internal competencies, behaviors, policies and procedures to ensure efficient work processes.
• May interact with providers and/or center administrators from time to time regarding billing and documentation policies, procedures, and conflicting/ambiguous or non-specific documentation.
• Other duties and responsibilities pertaining to medical coding compliance monitoring as requested by the Director of Medical Coding Compliance or Chief Compliance Officer.

Qualification Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Position requires constant mental alertness, attention to detail, and high degree of accuracy required in completing all assignments. Strong problem-solving skills. Smart, driven, exceptional work ethic. Must be able to follow oral and written instructions and follow -through on all assignments. Excellent organizational skills. Highly detailed-oriented. Ability to work well in a group setting and independently.

Education and/or Experience:

• Certified Professional Coder (CPC®) or CCS-P
• High School diploma, GED or equivalent.
• Minimum of 2 years of coding experience with an emphasis in Evaluation and Management coding.
• Experience in coding healthcare provider documentation to identify correct ICD-10-CM, CPT, and/or HCPCS codes preferred.
• An excellent understanding of Mental Health / Opioid Addiction medical terminology preferred.
• An excellent understanding of ICD-10-CM coding classification and CPT/HCPCS coding.
• Computer literate adept skill level on MS Office applications.
• Good organizational and communication skills.
• Task oriented and ability to meet designated deadlines and productivity standards.
• Strong, well-developed interpersonal skills.
• Experience in Mental Health or Addiction Medicine a plus.