Certified Medical Coder

CVCH•Wenatchee, WA

4d•Hybrid

About The Position

The Coder’s primary job function is to certify accurate billing for professional services and hospital procedures. This is accomplished through review of clinical encounters, confirming correct use of diagnosis and procedural codes and application of appropriate modifiers and CCI edits. The Coder provides education to providers to ensure proper completion of the medical record.

Requirements

High School Diploma or equivalent
AAPC Certification (American Academy of Professional Coders).
One year of coding experience in a healthcare setting preferred.
Knowledge of diagnosis and procedural coding, medical terminology and insurance billing guidelines.
Fluent with industry X12 and ANSI guidelines.
Proficient with claims adjustment reason and remark codes (CARC and RARC).
FQHC certification or billing experience.
English required.
Knowledge of computer applications and equipment related to work.
Basic computer and keyboarding skills.
Ability to enter data within company’s computer system.
Strong knowledge in MS Word/Excel.
Manual dexterity.
Strong customer service skills.
Strong process improvement background.
Strong interpersonal and communication skills.
Ability to work effectively with other staff and management.
Demonstrated skill in developing and maintaining productive work teams.
Ability to demonstrate personal integrity in all interactions.
Ability to make decisions in line with state and federal regulations.
Ability to read, comprehend, and analyze documents, regulations, and policies.
Ability to prepare and submit complete and succinct documents necessary to the job.
Ability to assess and evaluate, have attention to detail.
Knowledge of auditing and compliance procedures, quality assurance and improvement practices.
Understanding of the elements of sponsored clinical protocols including consent forms, and reporting requirements.
Problem solving and analytical skills are required with a heavy emphasis on detailed analysis of information to support actions.
Ability to read computer keyboard, monitor, and documents.
Ability to prepare and analyze documents.
Ability to read extensively.
Ability to see, recognize, receive and convey detailed information orally, by telephone and in person.
Ability to convey accurate and detailed instructions by speaking to others in person and by telephone.

Nice To Haves

Strong process improvement background.
Demonstrated skill in developing and maintaining productive work teams.

Responsibilities

Reviews clinical encounters presented via electronic lists to ensure proper submission of services prior to billing.
Edits and corrects diagnosis and procedural codes and applies modifiers and CCI edits as required according to coding guidelines and department policy.
Effectively utilizes coding software and/or books to confirm coding accuracy.
Verifies referring provider, rendering provider, department and other critical data elements are accurate prior to submission of completed coding.
Receives and reviews paper fee slips for hospital services and ensures proper coding of diagnosis and procedural codes.
Applies modifiers and CCI edits as required and supported by the documented medical record. Posts charges for final billing.
Utilizing approved methods, communicates incorrect application of procedure or diagnosis codes or incomplete medical documentation to providers.
Reports all unresolved non-compliant coding issues immediately upon discovery, as dictated by department or organizational policy.
Works with providers and clinical support staff to resolve coding and documentation concerns.
Meets on a regular basis with providers and clinical staff (for their assigned specialties) for the purpose of educating them on coding rule changes and/or coding trends and to answer coding questions.
Participates with educational activities with clinical departments, corporate compliance, etc. to ensure lines of communication among departments remains open and positive.
Is responsible to remain current with general billing guidelines, reimbursement rules and regulations.
Is responsible to remain current with their specific guidelines by reading payer publications and reviewing their websites.
Understands FQHC billing nuances to ensure accurate coding and maximum reimbursement for related services.
Attends conferences, seminars and webinars as requested to remain current on billing related policies.
Provides information as needed for production reporting and to ensure job standards are consistently met or exceeded.
Assists with internal audits by providing requested information and participating in review finding discussions regarding insurance processing performance.
Submits to remedial training if substandard performance is identified through such audits.
Assists co-workers and management with special projects related to claims or A/R clean- up efforts.
To ensure uninterrupted service, participates in cross-training efforts and provides coverage for insurance processing and follow-up needs with non-assigned payers.
Actively participates in departmental and/or organizational process improvement (lean) initiatives.
Notifies management of audit requests by insurance payers and complies with requests in a timely manner.
Performs other duties and tasks as assigned by supervisor.
Expected to meet attendance standards and work the hours necessary to perform the essential functions of the job.
Conforms to safety policies, general housekeeping practices.
Demonstrates sound work ethics, flexible, and shows dedication to the position and the community.
Demonstrates a positive attitude, is respectful, and possesses cultural awareness and sensitivity toward clients and co-workers.
Keeps customer service and the mission of the organization in mind when interacting with all clients, co-workers, and others.
Employees are expected to embrace, support and promote the core values of respect, integrity, trust, compassion and quality which align with the CVCH mission statement through their actions and interactions with all patients, staff, and others.
Conforms to CVCH policies and Joint Commission and HIPAA regulations.