Certified Professional Coder

Odessa Regional Medical Center•Odessa, TX

10h

About The Position

This role involves analyzing patient charts, physician notes, and discharge summaries to ensure documentation is complete and accurate before coding. The Certified Professional Coder will translate diagnoses and procedures into standardized codes using ICD-10-CM, CPT, and HCPCS, ensuring codes accurately represent services provided. Adherence to healthcare laws and regulations, including HIPAA and Medicare/Medicaid guidelines, as well as company policies, is crucial. The position aims to prevent coding errors that could lead to claim denials or audits. Responsibilities include working with billing teams to submit coded claims, verifying claim accuracy for proper reimbursement, and fixing rejected or denied claims. Effective communication with healthcare providers and insurance companies, along with protecting sensitive patient information and following strict privacy and data security standards, are key aspects of this role. The coder will clarify documentation with physicians when needed, collaborate with billing and administrative teams, and regularly update knowledge of coding systems and regulations. Maintaining certification through continuing education, performing coding audits and compliance reviews, and training new coders or staff are also part of the duties. Specialization in areas like inpatient, outpatient, or specialty coding may be required. Additionally, the role includes posting charges into the billing system within 24-48 hours, performing other billing functions under supervision, identifying potential billing errors, verifying patient coverage and demographic information, and contributing to the improvement of billing procedures and processes. Escalating problem claims to management and communicating effectively with clinic/administrative personnel, assigned coders, and the CLT-Team are also expected. Completing assigned training and education is mandatory.

Requirements

High School diploma or GED equivalent
Medical billing and coding training program - Certificate or associate degree
Demonstrates experience with medical billing, CPT and ICD-10 codes, Revenue Cycle
Ability to exercise discretion on sensitive and confidential matters
Demonstrate ability to communicate effectively on the phone, in writing and via email
Demonstrates computer skills with data entry software, Microsoft Word, and Excel
Knowledge of medical terminology, anatomy, and healthcare regulations
Insurance, banking, hospital medical office or other experience with extensive customer service contact
One or more years of billing and coding experience in medical field - required in the medical field.

Nice To Haves

Bilingual Preferred

Responsibilities

Analyze patient charts, physician notes and discharge summaries
Ensure documentation is complete and accurate before coding
Translate diagnoses and procedures into standardized codes using ICD-10-CM (diagnoses), CPT (procedures), and HCPCS (supplies/services)
Make sure codes correctly represent services provided
Follow healthcare laws and regulations (HIPAA, Medicare/Medicaid guidelines) and Company Policies
Prevent coding errors that could lead to claim denials or audits
Stay updated on coding changes and updates
Work with billing teams to submit coded claims to insurance companies
Verify claim accuracy to ensure proper reimbursement
Fix rejected or denied claims by reviewing and correcting codes
Communicate with healthcare providers and insurance companies
Protect sensitive patient information
Follow strict privacy and data security standards
Clarify documentation with physicians when needed
Collaborate with billing and administrative teams
Regularly update knowledge of coding systems and regulations
Maintain certification through continuing education
Perform coding audits and compliance reviews
Train new coders or staff
Specialize in areas like inpatient, outpatient, or specialty coding
Post charges into billing system within 24-48 hours and completes other billing functions under direction of supervisor
Identifies possible billing errors that might prevent the claim from being processed on the insurance company level
Verifies patient coverage and demographic information, draws conclusions, and corrects billing errors or other Claim issues
Contributes to improvement of billing procedures and processes
Escalates problem claims to management as required by circumstances
Communicate effectively with clinic/administrative personnel, assigned coder and CLT-Team
Completes assigned training and education