CLINIC CODER

McDonough District Hospital•Macomb, IL

About The Position

Reviews, analyzes, codes, and abstracts physician services and clinic-based professional fee encounters to ensure accurate assignment of diagnoses, procedures, and services in accordance with current coding guidelines, documentation requirements, and applicable payer policies. Assigns ICD-10-CM diagnosis codes, CPT procedure codes, and HCPCS Level II codes, as applicable, to support accurate billing, reimbursement, regulatory compliance, and quality reporting. Reviews medical record documentation for completeness, consistency, and coding accuracy; identifies documentation deficiencies, coding discrepancies, and potential compliance concerns; and communicates with providers and appropriate staff to obtain clarification when needed. Uses coding references, encoder software, and other available resources to research and resolve coding questions. Maintains established coding accuracy and productivity standards and supports continuous improvement in coding quality and revenue cycle performance.

Requirements

High school diploma or equivalent required.
Current coding certification through AAPC or AHIMA required; acceptable credentials may include CPC, CCS, CCS-P, or another approved credential appropriate to the position.
Knowledge of ICD-10-CM diagnosis coding conventions, sequencing requirements, official guidelines, and annual code updates.
Knowledge of CPT coding for professional fee evaluation and management services, procedures, and other physician services.
Knowledge of applicable HCPCS Level II codes.
Ability to analyze medical documentation, identify relevant clinical information and deficiencies, and determine appropriate code assignment.
Knowledge of coding compliance, official guidelines, payer policies, medical necessity requirements, and regulatory standards.
Knowledge of evaluation and management coding guidelines, including medical decision-making, time-based coding when appropriate, and documentation requirements.
Proficiency using electronic health records, encoder software, coding references, and online resources.
Understanding of revenue cycle fundamentals, including the relationship between coding, claims, reimbursement, medical necessity, denials, and compliance.
Working knowledge of medical terminology, anatomy, physiology, and common disease processes.
Strong accuracy and attention to detail; expected to maintain a coding accuracy standard of 95% or higher.
Analytical and problem-solving ability, including researching questions, recognizing inconsistencies, and exercising sound coding judgment.
Ability to organize and prioritize work, manage deadlines, and meet productivity targets without compromising accuracy or quality.
Clear, professional, and tactful communication with providers, clinic staff, billing personnel, and revenue cycle colleagues.
Ability to work independently with minimal supervision, accept accountability for coding decisions, respond constructively to feedback, and participate in ongoing education and performance improvement.
Ability to maintain confidentiality and handle protected health information appropriately.

Nice To Haves

Minimum of 2–3 years of professional medical coding experience preferred.
Demonstrated experience coding physician office or ambulatory professional fee services strongly preferred.
Experience with multiple clinic specialties, particularly primary care, OB/GYN, pediatrics, general surgery, gastroenterology, orthopedics, and wound care, preferred.
Previous medical billing, claims review, or revenue cycle experience is a plus.
Experience with electronic health records, encoder software, and computerized coding resources preferred.

Responsibilities

Review, analyze, code, and abstract physician services and clinic-based professional fee encounters.
Assign applicable ICD-10-CM diagnosis codes, CPT procedure codes, and HCPCS Level II codes.
Review medical records for completeness, consistency, and coding accuracy.
Identify documentation deficiencies, coding discrepancies, and potential compliance concerns.
Communicate with providers and appropriate staff to clarify documentation and coding questions.
Use coding references, encoder software, and other resources to research and resolve coding questions.
Meet established coding accuracy and productivity standards.
Support continuous improvement in coding quality and revenue cycle performance.
Maintain confidentiality of protected health information and comply with organizational policies and applicable regulations.
Maintain coding certification and stay current with annual coding and guideline changes.