Certified Medical Coder

Great Plains Tribal Leaders Health • Rapid City, SD

6d • Onsite

About The Position

The Certified Medical Coder position at the Oyate Health Center (OHC) Patient Accounts Department is responsible for converting medical diagnoses, supplies, and processes into standardized codes for insurance claims. This role ensures compliance with Medicare, Medicaid, and private insurance regulations. Key duties involve applying knowledge of HIPAA, HITECH, and coding guidelines (ICD-10, CPT 4, HCPCS). The coder analyzes medical records to reflect secondary complications and comorbidities, codes diagnoses and procedures accurately, and ensures the validity and completeness of provider documentation. This includes selecting principal diagnoses and procedures, proper sequencing, and verifying documentation supports medical necessity. The position requires ensuring all components of the medical record are present and complete, including identification, signatures, dates, and comprehensive notes. The coder will examine and modify the level of services based on documentation, complete medical records by reviewing information, notify providers of deficiencies, track outstanding records, and resolve discrepancies. The incumbent works independently, communicates proactively with providers and billing staff on coding/documentation issues, and participates in performance improvement teams and committees. Compliance with federal laws and regulations, including HIPAA, is mandatory. The role also involves performing related duties accurately and timely, maintaining reliable attendance, effective communication, and utilizing required systems and tools.

Requirements

• Completion of a formal training program or an associate’s degree and one (1) year of relevant experience; or a high school diploma or GED and three (3) years of relevant experience.
• Certified Medical Coding Certification.
• Applicable education or experience applying a body of standardized rules, procedures, or operations to perform the full range of standard clerical assignments and resolve recurring problems or to operate and adjust varied equipment.
• Must comply with federal laws and regulations as required by the Health Insurance Portability and Accountability Act (HIPAA).
• Ability to perform the essential functions of the job, with or without reasonable accommodation.
• Must be able to read, write, speak, and hear.

Nice To Haves

• Knowledge of Health Insurance Portability and Accountability Act (HIPAA) and Health Information Technology for Economic and Clinical Health Act (HITECH).
• Knowledge of medical records requirements and functions.
• Knowledge of ICD-10 (International Classification of Diseases), CPT 4 (Current Procedural Technology) and HCPCS (Healthcare Common Procedure Coding System) coding guidelines.

Responsibilities

• Convert medical diagnosis, supplies and processes into standardized codes for insurance claims.
• Ensure compliance with Medicare, Medicaid, and private insurance rules and regulations.
• Analyze and abstract information from medical records to reflect secondary complications and comorbidity conditions.
• Code diagnosis and/or procedures from medical records, assuring validity and completeness.
• Code complex and difficult records accurately, selecting principal diagnosis and procedure, sequencing codes properly, and verifying documentation supports medical necessity.
• Ensure all components of the medical record are present and complete.
• Examine and modify the level of services based on documentation.
• Complete medical records by reviewing information, notifying health care providers of deficiencies, tracking outstanding records, and resolving discrepancies.
• Communicate with Providers and Billing staff on coding/documentation issues.
• Participate on performance improvement teams and other committees as assigned.
• Comply with federal laws and regulations as required by the Health Insurance Portability and Accountability Act (HIPAA).
• Perform related duties accurately, timely, and in accordance with established standards.
• Maintain regular and reliable attendance consistent with the position’s schedule and operational needs.
• Communicate effectively with internal and external stakeholders.
• Adhere to all applicable policies, procedures, and regulatory requirements.
• Utilize required systems, tools, and technology necessary to perform the job.

Benefits

• Compliance with our Employee Health Procedure is a condition of employment.
• You are required to agree that you will comply with all job-related employee health screening and immunizations prior to your first day of employment.
• Required immunizations: MMR (Measles, Mumps and Rubella, Varicella (Chicken Pox), Hepatitis B, Influenza, T-dap (Tetanus - Diphtheria - Pertussis), and COVID-19 vaccination.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED