Basic Function: The Coder will be responsible for ensuring that claims have the correct CPT and ICD-9 codes in compliance with CMS and other payer guidelines, correct denied or rejected claims based on correct coding and CPT guidelines. May be required to code medical records utilizing ICD-9-CM and CPT coding conventions. Responsible for applying the appropriate diagnostic and procedural codes to individual patient health information for data retrieval, analysis and claims processing.
High School Graduate required, Associate Degree or some post-secondary education desired.
American Academy of Procedural Coders (AAPC);Certified Coding Specialist (CCS), Certified Procedure Coder (CPC), or RHIT/RHIA required
Two years of experience in abstracting and coding information from patient records using ICD-9-CM and the CPT-4 coding systems or work as coder in a physician practice or billing office, preferred.
Demonstrates excellent knowledge of proper use of ICD-9-CM and CPT-4 coding guidelines and principles.
Accredited training in Medical Terminology and Human Anatomy and Physiology required.
Demonstrates excellent interpersonal and communication skills.
Demonstrates ability to work independently.
Demonstrated ability with MS office applications required.
Experience with Coding software required.
Experience in health information management, physician medical office, registration or billing experience preferred.
Ensure that claims processes meet current CPT, CMS and other payer guidelines in order to meet standards of compliance and maximize reimbursement. This may requires the review of medical records and other patient related data.
Assist with the resolution of denied or rejected claims as it relates to areas of coding and billing.
Assist with training of employees regarding coding, billing compliance and medical terminology.
Participates in required continuing education and compliance training programs to maintain an understanding of anatomy and physiology, medical terminology, disease processes and surgical techniques to support the effective application of ICD-9-CM and CPT coding guidelines to inpatient and outpatient diagnoses and procedures.
Maintain claim edit work queues and Allscripts work queues at prescribed levels.
Analyze data and make recommendations for process improvements.
Reflects behaviors and conduct consistent with religious sponsorships and the articulated values of HSHS Medical Group.
Supports the mission, philosophy and goals of Hospital Sisters Health System Supports the mission, philosophy and goals of Hospital Sisters Health System
Adhere to HSHS core values of Care, Respect, Joy, and Competence
Other duties as assigned.