Coder I
About The Position
The Coder I reviews E&M and simple visit charges submitted by providers in assigned work queues, validating level of service, place of service, new versus established status, and modifiers to support valid claim creation. The role also reviews and enters manual charges for external services and reviews and resolves simple NCCI, LCD, and MUE edits. The position is in Clinic Billing Services and reports to the Manager-Coding and Charge Capture. It is a full-time, 40-hour-per-week role with an 8-hour day shift. The required coding certification must be obtained within 18 months of hire.
Requirements
- High school diploma, GED, or higher-level degree.
- One year of experience in billing/charge capture coding or related services.
- CPC-A, CPC, CSC, or RHIT coding certification within 18 months of hire.
- Ability to use Microsoft Office Suite (Word, Excel, Outlook, and PowerPoint) and other relevant software applications.
- Familiarity with coding software.
- Knowledge of the denial and appeals process.
- Knowledge of general CMS and billing guidelines.
- Knowledge of ICD-10-CM and CPT/HCPCS coding conventions.
- Knowledge of medical terminology, anatomy, and physiology.
- Written and verbal communication skills.
Nice To Haves
- Enrolled in a coding certification program or holding an Apprentice Certificate in coding, such as CPC or CCS.
- Coursework in medical terminology, anatomy, and physiology.
Responsibilities
- Demonstrate compliance with the Code of Conduct and compliance policies, resolve compliance questions or concerns, and report suspected violations.
- Maintain quality of work based on current published standards.
- Review documentation and sequence diagnoses and procedures using current coding guidelines for E&M and simple visit encounters.
- Complete claim information and validate claims for split or non-split payers.
- Communicate with Coder IIs, department management, and clinic staff to obtain documentation needed for correct billing.
- Complete assigned work queue assignments within departmental productivity standards.
- Maintain a 95% accuracy rate.
- Maintain a thorough understanding of anatomy and physiology, medical terminology, and disease processes through continuing education to apply ICD-10-CM and CPT-4 coding guidelines to inpatient and outpatient simple visit encounters.
- Review and enter manual charges submitted by providers for external services.
- Review and resolve simple NCCI, LCD, and MUE edits.
- Perform other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
