Coder I
About The Position
A Coder I performs coding audits for quality checks and provider education. This role maintains working knowledge of coding and compliance, provides coding training and support to all TPMG locations, and participates in coding-related denial meetings. The Coder I performs coding and auditing of medical record documentation to ensure accurate coding. They are responsible for reviewing and submitting documentation for all Recovery Audit Contractors (RAC) requests, including timely follow-up of RAC audits. Additionally, they review and submit documentation for all Error Rate Testing (CERT) requests with timely follow-up of CERT responses, review and submit documentation for Targeted Probe and Educate (TPE) requests, and review and submit documentation for medical record requests for all insurance carriers. The role adheres to HIPPA guidelines, works with providers and clinical staff to improve documentation, and collaborates with the Central Billing Office team to ensure appropriate reimbursement. The Coder I reviews denied claims and retractions, makes appropriate corrections, or advises if a denial/retraction is warranted, and provides assistance with submitting appeals for denials/retractions. This position works closely with Coding and Compliance Auditors and the SWAT Team. Other duties may be assigned.
Requirements
- Knowledge of CPT, ICD-9, ICD-10 and HCPCS coding.
- Knowledge of appropriate medical terminology.
- Ability to read and understand oral and written instructions and follow written protocols.
- Ability to examine documents for accuracy and completeness.
- Ability to provide excellent customer service.
- Ability to multi-task.
- Skill in presenting information in an organized manner.
- Skill in verbal and written communication.
- High School diploma/GED.
- Up to 2 years related experience/training.
- Up to 2 years in the medical billing field, with coding experience.
- Possess and maintain active CPC, CCS, COC, CCS-P, or CCA certification required.
Nice To Haves
- Experience with NextGen and Encoder Pro is a plus.
Responsibilities
- Performs coding audits for quality checks and provider education.
- Maintains working knowledge of coding and compliance.
- Provides coding training and support to all TPMG locations.
- Participates in coding-related denial meetings.
- Performs coding and auditing of medical record documentation to ensure accurate coding.
- Reviews and submits documentation for all Recovery Audit Contractors (RAC) requests; timely follow-up of RAC audit.
- Reviews and submits documentation for all Error Rate Testing (CERT) requests with timely follow up of CERT response.
- Reviews and submits documentation for Targeted Probe and Educate (TPE) requests.
- Reviews and submits documentation for medical record requests for all insurance carriers.
- Follows HIPPA guidelines.
- Works with providers and clinical staff to improve documentation.
- Works with the Central Billing Office team to ensure appropriate reimbursement.
- Reviews denied claims and retractions and makes appropriate corrections or advise if denial/retraction is warranted.
- Provides assistance with submitting appeals for denials/retractions.
- Works closely with Coding and Compliance Auditors and SWAT Team.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
