Coder II, Breast Surgeon

Job Summary

The Coder II at North Mississippi Health Services is responsible for ensuring timely and accurate billing and reimbursement for inpatient, outpatient, and ambulatory records including assigning diagnostic and procedural codes according to patient record and documentation, monitoring reimbursement, and investigating denials. This role engages broad knowledge and collaborates with the Coding & Reimbursement Manager to accurately apply coding guidelines, coordinate with external parties and payers for reimbursements, and ensure compliance with all relevant policies, procedures, and guidelines.

Coding

JOB FUNCTIONS

• Assign diagnostic and procedural codes using ICD-10-CM and CPT coding systems for inpatient, outpatient, and ambulatory surgery records in order to ensure accurate billing and statistical information by reviewing provider documentation.
• Apply coding knowledge of ICD-10-CM and CPT to denial review to ensure accurate coding, compliance and reimbursement.
• Research and apply coding/billing guidelines for various carriers. Knowledge of Hierarchical Condition Category coding to ensure accurate diagnosis coding and future reimbursement. Reimbursement:
• Apply local Medical Review Policies regarding medical necessity to all insurance carrier’s procedures to ensure appropriate reimbursement for the provided service.
• Follow up with insurance carriers on outstanding appeals and/or incorrect allowable/reimbursement. Identify reimbursement opportunities through documentation review and denials for NMMCI and MSOs. Denials:
• Research causes for insurance denials by reviewing provider documentation, medical policy, and coding guidelines.
• Determine if the documentation is compliant with guidelines and supports all services billed.
• Decide if the denial can be sent for appeal, the provider be held accountable, or if patient is responsible.
• Make corrections to patient account and with insurance carrier as needed. Compliance:
• Abide by NMHS Coding Compliance Policy, ICD-10-CM and CPT Coding Guidelines and Standards of Ethical Coding.
• Determine if provider's documentation meets coding guidelines and involve the Coding Specialist to provide education as needed. Customer Service:
• Interact effectively and assist NMMCI and MSO clinic managers, charge entry personnel, and physicians with determining appropriate CPT codes for their charges, coding guidelines, medical policies and education to gain trust, commitments, and a strong work relationship.
  
  

Qualifications

Education

• Associate's Degree Health Information Management. Required
• High School Diploma or GED Equivalent Willing to consider HIghSchool Diploma in lieu of Assoc Degree with 4 years of experience beyond the minimum required experience. Required
  
  

Licenses and Certifications

• RHIT - Registered Health Information Technician. . within 180 Days. Required
• RHIA - Registered Health Information Administrator. . within 180 Days. Required
• Certified Coder-AHIMA or AAPC. CPC (Certified Professional Coder). within 180 Days. Required
• CCS-Certified Coding Specialist. . within 180 Days. Required
  
  

Work Experience

• 1-3 years. At least 1 year previous outpatient coding experience with and CPT coding schemes, including evaluation and management codes and experience with insurance carriers. Preferred
  
  

Skills

Knowledge Skills and Abilities

• Coding and research skills; required.
• Thorough knowledge of medical terminology.
• Previously completed course in basic anatomy.
• Ability to read and interpret medical record documentation.
• Ability to operate PC.
• Assist CBO, clinic and MSO staff with special needs for coding and billing information.
• Must be conscientious to detail and work well within a team oriented structure.
• Ability to organize daily tasks and work independently in order to accomplish tasks in a timely manner.
• Excellent communication skills are necessary to interact with physicians, clinic staff, MSO and CBO staff, and insurance company personnel.
• Must display professional attitude in all situations.
• Ability to gather and share information with knowledge, tact and diplomacy.
  
  

Physical Demands

A thorough completion of this section is needed for compliance with legal standards such as the Americans with Disabilities Act. The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

• Standing . Constantly
• Walking . Frequently
• Sitting . Rarely
• Lifting/Carrying . Frequently 50 lbs
• Pushing/Pulling . Frequently
• Climbing . Occassionally
• Balancing . Occassionally
• Stooping/Kneeling/Bending . Frequently
• Reaching/Over Head Work . Frequently
• Grasping . Frequently
• Speaking . Occassionally
• Hearing . Constantly
• Repetitive Motions . Constantly
• Eye/Hand/Foot Coordinations . Frequently
  
  

Benefits A****vailable

• Continuing Education
• 403B Retirement Plan with Employer Match Contributions
• Pet, Identity Theft and Legal Services Insurance
• Wellness Programs and Incentives
• Referral Bonuses
• Employee Assistance Program
• Medical Benefits
• Dental Benefits
• Vision Benefits
• License Certification Reimbursement
• Life, Long-Term and Short-Term Disability, Group Accident, Critical Illness and Hospital Indemnity Insurance
• Employee Discount Program
• Other:
• Early Access to Earned Wages
• Tuition Assistance
• Relocation Assistance
• Paid Time Away
• Special Employee Rates at NMMC Wellness Centers