Coder, Certified Professional - FT Days

Three Crosses Regional Hospital•Las Cruces, NM

About The Position

The Certified Coder is responsible for timely and accurate coding of administrative and clinical data using ICD-10-CM, ICD-10-PCS, and/or CPT codes. The position ensures compliance with federal regulations, state licensing requirements, and Three Crosses Regional Hospital policies and procedures. The incumbent is expected to uphold high ethical and moral standards and support the hospital’s mission, vision, and values. The role analyzes claims before and after payment, reviews medical records for coding and billing issues, and documents findings and coding rationale. The Certified Coder also identifies process gaps, supports accurate documentation and claim submission, resolves discrepancies, and collaborates with clinical staff and the Director of Revenue Cycle to advance claims through the revenue cycle. The position requires maintaining the confidentiality of protected health information and meeting established productivity, accuracy, timeliness, and documentation standards.

Requirements

High school diploma or equivalent.
One required certification: CCA, CPC, CPB, CCS, CIC, COC, or CCS-P accredited by AAPC or AHIMA.
Meet all Employee Health Requirements.
Demonstrate critical-thinking, time-management, and problem-solving skills.
Excellent verbal and written communication skills, including documentation.
Ability to organize and prioritize tasks.
Experience with an electronic medical records system.
Experience with medical record documentation and medical chart auditing or quality.
Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology.

Nice To Haves

Three or more years of medical coding experience.

Responsibilities

Independently analyze claims on a pre- and post-payment basis using clinical, coding, and claims-processing knowledge to ensure accuracy in accordance with CPT, ICD-10, and risk adjustment guidelines.
Review medical records to validate or invalidate potential coding and billing issues identified on claims.
Develop and maintain an individual audit schedule in coordination with leadership and providers.
Document findings thoroughly to support claim adjustments, including supporting medical records and coding rationale.
Identify and document process gaps that contribute to incorrect payments.
Ensure the security and confidentiality of protected health information accessed during work activities.
Apply clinical and coding expertise to ensure accurate and complete documentation for coding and claim submission.
Report missing charges and reconcile discrepancies before claim submission.
Identify opportunities to educate providers, staff, and colleagues on documentation and coding best practices.
Meet established productivity, accuracy, timeliness, and documentation standards.
Collaborate with clinical staff and the Director of Revenue Cycle to resolve coding queries and support claim progression through the revenue cycle.
Adapt to new systems, technologies, and coding updates.
Attend staff meetings as required.
Perform other duties as assigned.