Clinic Professional Medical Coder

JOB SUMMARY:

The Clinic Professional Coder is responsible for the accurate review, assignment, and validation of diagnosis, procedure, and professional fee codes to support compliant billing and reimbursement processes. This position reviews provider documentation, assigns appropriate ICD-10-CM, CPT, HCPCS, and Evaluation and Management (E/M) codes, and ensures all services rendered are accurately captured and billed. The coder serves as a resource to providers and staff regarding coding guidelines, documentation requirements, reimbursement regulations, and charge capture opportunities.

JOB RELATIONSHIPS:

• Reports directly to the HIM Director
• Works closely with HIM personnel, Revenue Cycle and Business Office staff, fellow coding team members, and external billing vendors

RESPONSIBILITIES AND ESSENTIAL DUTIES:

• Review clinical documentation to accurately assign:
  • ICD-10-CM diagnosis codes
  • Appropriate E&M levels
  • CPT procedure codes
  • HCPCS Level II codes
  • Vaccines, immunizations, allergy injections, and other injectable codes
• Code and bill professional charges for:
  • Rural Health Clinic (RHC) services
  • Ambulatory Surgery services
  • Emergency Room professional services

• Interpret medical record documentation and apply appropriate coding guidelines.
• Knowledge of Medicare, Medicaid, and commercial payer guidelines.
• Work closely with billing staff, patient accounts personnel, and external billing entities to review, correct, and resolve coding and billing issues affecting claim submission and reimbursement.
• Review and respond to work items assigned via the Revenue Cycle work queue that require coding clarification, documentation review, and/or charge corrections.
• Perform other duties as assigned to support organizational objectives.

QUALIFICATIONS:

• Experience coding professional fees for Rural Health Clinics, Emergency Departments, and Ambulatory Surgery services.
• Demonstrated ability to work independently while maintaining productivity and quality standards.

EDUCATION:

• Current coding certification from:
  • American Health Information Management Association (AHIMA), or
  • American Academy of Professional Coders (AAPC)

OR

• Relevant professional coding experience may be considered in lieu of certification.

TRAINING AND EXPERIENCE:

• Inpatient and outpatient E&M coding experience preferred
• Experience with hospital and rural health clinic billing, reimbursement, and coding preferred.

WORKING ENVIRONMENT:

• Work is primarily performed in a remote office environment with periodic onsite presence required.
• Regular interaction with leadership, providers, co-workers, third-party billing vendors, and payers through virtual and in-person communication.
• Frequent use of computers, electronic health record systems, and telecommunication platforms.
• Participation in virtual and onsite meetings
• Must maintain a secure remote work environment and protect confidential patient and financial information in compliance with HIPAA and organizational policies.

PHYSICIAL REQUIREMENTS:

• Ability to sit for extended periods while working on a computer and participating in virtual meetings.
• Ability to occasionally stand, walk, bend, reach, and move throughout the hospital and clinic facilities during onsite visits.
• Ability to lift up to 20 pounds occasionally.
• Ability to operate standard office equipment, computers, and communication devices.