Over the years, Ophthalmology LTD's name has become associated with the highest quality of comprehensive medical and surgical eye care. Highly trained ophthalmologists, as well as experienced optometrists, combine their considerable expertise to give each and every patient the best possible care. Ophthalmology LTD delivers treatment for cataracts, glaucoma, and diabetic eye disease, as well as cornea transplants, oculoplastic surgery, retina surgery, vitreoretinal surgery, and pediatric eye care in Sioux Falls.

Ophthalmology LTD is looking to add a Medical Coder to our team. This person will be responsible for coding clinical and outpatient medical records using the most accurate and appropriate ICD-10-CM and CPT codes in accordance with regulatory coding guidelines, best practices in the industry, and Ophthalmology LTD policy and procedures. 

A summary of the job duties include:

• Demonstrate extensive knowledge of official coding guidelines established by the AMA and CMS with regard to the assignment of ICD-10 and CPT.
• Evaluates medical record documentation to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflect and support outpatient visits.
• Ensure codes are accurate and sequenced correctly in accordance with government and insurance regulations.
• Respond to coding questions/issues and reimbursement questions from clinical staff and other departments as necessary.
• Performs scheduled audits of provider coding and documentation to make recommendations for improvements and enhancements. 
• Maintains a close working relationship with assigned providers and medical office personnel, frequently querying the provider when coding discrepancies arise. Support the provider's success by providing necessary resources and materials.
• Researches coding questions the provider or medical staff may have, and presents findings to them.
• Review ABNs and confirm that the form is valid with regard to the information entered on it.
• Stays current regarding knowledge of updated federal and state regulations, laws, and new procedures.
• Work with Business Office staff in developing efficient coding processes by reviewing incoming EOBs or denials.
• Performs coding and documentation assessments to determine any issue relating to coding, documentation, or missed revenue opportunities and delivers individualized training based on these findings.
• Obtains authorizations prior to procedures or surgical services being performed.
• Assist department leadership with research, analysis, and all other special projects.
• Answer phone calls and direct calls to the appropriate areas.
• Financial counseling of patients prior to medical services being performed and work with the Billing/Insurance Manager and/or CEO on exceptions to standard procedures.

Education and Training requirements:

• High School Diploma or equivalent.
• Prefer post-secondary education courses in accounting and business. Prefer educational courses in CPT and ICD coding in medical practice and a thorough understanding of medical terminology and anatomy. Certification is encouraged (CPC-Certified Professional Coder, Revenue Cycle Management).
• Ophthalmology coding and billing experience preferred; must have a minimum of 2 years of medical coding experience in a physician office setting or equivalent with knowledge of various medical payer practices and insurance laws/guidelines (Medicare, Medicaid, Work Comp, VA, and other third-party payers).

Please note this job description is not a complete listing of activities, duties, or responsibilities that are required for this job. Duties, responsibilities, and activities may change at any time.

This position is a full-time, non-exempt role. Ophthalmology LTD office hours are Monday – Friday, 8 am – 5 pm. We offer a competitive compensation and comprehensive benefits package including health, dental, 401K, life insurance, AD&D, short and long-term disability, PTO, sick leave, paid holidays, and eye care benefits.