Responsible for ensuring accuracy as well as verifying completed and precise medical record(s) for the interpretation of clinical documentation completed by the medical staff to correctly assign appropriate ICD10, CPT and/or HCPCS codes for professional coding. Coders for Steward Medical Group are part of a national team, with each Coder assigned to a specific geographic area, specialty and/or provider as per the needs of the company.

KEY RESPONSIBILITIES:

• Maintain department processes and controls according to Professional Coding Standards, CMS Standards, HIPAA, OIG, and the State guidelines as well as national payor coding guidelines as they pertain to professional coding and reimbursement.
• Communicate with providers and practices to ensure accuracy on all documentation and encounter forms, including follow-up with the provider and/or clinical staff on documentation that is insufficient or unclear.
• Complying with medical coding guidelines and SMG policies. Ensuring codes are accurately assigned and sequenced correctly in accordance with government and insurance regulations.
• Demonstrate understanding of National and Local Coverage Determinations as per MAC region.
• Ability to maintain the confidentiality of PHI as per HIPAA and SMG requirements.
• Exhibit sound knowledge of anatomy and physiology, medical terminology, surgical terminology, pharmacological terminology, patient care documentation terminology.
• Researching information in cases where the coding is complex or unusual. Disseminate information regarding new or updated codes and/or coding policies either by payer or through guidelines and regulations.
• Demonstrate basic knowledge of the Revenue Cycle and the impact of coding decisions on revenue cycle.
• Reviewing and processing insurance denials, analyzing Explanation of Benefits (EOB) forms to ensure insurance companies have properly paid for charges. Identifying denial trends and forwarding to coding management.
• Manage multiple work demands simultaneously to maintain relevant productivity and turnaround time standards for completing.
• Maintain current credentials through continuing education CEU’s as per certification requirements. Other duties as assigned.

REQUIRED KNOWLEDGE & SKILLS:

• Demonstrated coding (ICD-10-CM, CPT and HCPCS) expertise. Ability to pass post-interview coding test.
• Computer literacy of medical information systems, records management software, encoders.
• Good computing knowledge in Microsoft Outlook, Word, Excel, PowerPoint etc.
• Excellent communication and customer service skills, both verbal and written.
• Understanding of third party reimbursement rules and regulations. Medical Billing experience preferred.
• Outstanding organizational, detail oriented and time management skills.
• Ability to work independently as well as part of a team when necessary.
Excellent typing and 10-key speed and accuracy.

EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:

• Current medical coding certification CPC, CCS-P, RHIA or other nationally recognized coding credential.
• 2 years of work experience as a medical coder. Professional Physician (ProFee) coding experience, preferred.