CERTIFIED CODER

POSITION TITLE: Certified Coder

REPORTS TO (TITLE): Director of Revenue Cycle

HOURLY RANGE: $31.00 - $42.74 DOE

Job Summary: The Certified Professional Coder is accountable for ensuring coding compliance for services performed by physicians and non-physician providers (e.g., nurse practitioners and physician assistants) and adhering to government regulations and coding guidelines. This position requires current, in-depth knowledge of coding governmental and commercial rules and regulations, including regulatory compliance requirements.

Specific Tasks/Duties Include:

• Perform physician/non-physician provider documentation audits for compliance and regulatory requirements.
• Perform coding data audits to validate documentation supports services rendered for reimbursement and reporting purposes.
• Perform medical record review to abstract information required to support accurate coding for professional provider encounters.
• Identify documentation deficiencies and properly query providers for proper code capture.
• Partake in educating and training providers and other professionals in appropriate coding
• Researches, analyzes, recommends, and facilitates a plan of action to correct discrepancies and prevent future coding errors.
• Assigns accurate CPT, HCPCS, and ICD medical codes for diagnoses and procedures.
• Ensure that codes are assigned correctly and sequenced appropriately as per government and insurance regulations.
• Code review for medical necessity, claims denials, billing issues, and charge capture.
• Assist in the development and implementation of policy and procedures for the understanding of how to integrate medical coding and payment policy changes into the practice's reimbursement processes.
• Assist in the integration of coding and reimbursement rule changes and updating the Charge Description Master (CDM), including the appropriate application of modifiers.
• Assist in regular, weekly/monthly meetings with departmental site directors and medical directors and provides information related to coding review findings and regulatory coding updates.
• Serves as resource and subject matter expert to other staff.
• Provides ongoing support and training on all aspects of medical coding.
• Other duties as assigned by Director of Revenue Cycle.

Education and Experience:

• CPC Certification required
• COC Certification preferred but not required
• CPMA Certification preferred but not required
• At least 4 years of experience in physician/non-physician provider documentation review and ensuring coding compliance, to government regulations and coding guidelines within the healthcare industry, preferably in an FQHC setting.

Minimum Qualifications:

• A strong understanding of physiology, medical terms and anatomy.
• Coding proficiency with CPT, HCPCS, and ICD-10.
• Knowledge of Medicare, Medicaid, Managed Care coding guidelines and regulations, including compliance and reimbursement.
• Experience with eClinicalWorks preferred.
• Strong computer skills with knowledge of various EHR systems preferably eClinicalWorks.
• Strong analytical skills with the ability to identify trends and present information in a succinct and actionable manner.
• Exceptional customer service orientation with a focus on collaboration and flexibility when working with both external and internal stakeholders.
• Demonstrate clear knowledge of SRCH structure, standards, procedures, and protocols.

SRCH is an equal opportunity employer to all, regardless of age, ancestry, color, disability (mental and physical), exercising the right to family care and medical leave, gender, gender expression, gender identity, genetic information, marital status, medical condition, military or veteran status, national origin, political affiliation, race, religious creed, sex (includes pregnancy, childbirth, breastfeeding, and related medical conditions), and sexual orientation.

Physical Requirements:

While performing the duties of this job, this position is frequently required to do the following:

• Use standard office equipment and access, input, and retrieve information from a computer.
• Use computer keyboard with manual and finger dexterity and wrist-finger speed sufficient to perform repetitive actions efficiently for extended periods of time.
• Communicate effectively in person or via telephone in a manner, which can be understood by those with whom the person is speaking, including a diverse population.
• Give and follow verbal and written instructions with attention to detail and accuracy.
• Perform complex mental functions; collect, interpret, and or analyze complex data and information.
• Vision: see details of objects at close range.
• Coordinate multiple tasks simultaneously.
• Reach forward, up, down, and to the side
• Sit or stand for minimum periods of one hour at a time and come and go from the work area repeatedly throughout the day.
• Lift up to 20 pounds.

SRCH provides reasonable accommodation for individuals with a physical or mental disability to apply for jobs and to perform the essential functions of their jobs unless it would cause an undue hardship.