Coder, Provider Practice - Behavioral Health

Sanford Health

1d•Remote

About The Position

Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland. Our Coders review medical documentation, assign appropriate codes (ICD-10, HCPCS, CPT), and ensure compliance with coding standards, regulations, and company procedures. The position requires strong problem-solving skills, effective communication with medical professionals to improve documentation accuracy and the ability to work independently. We offer flexible hours and the ability to work remotely. Pay starts at $19.00/hr with additional credit given for work experience relative to this role. Serve as a resource for providers in understanding covered indications and the supporting documentation. Supports both technical and professional services in provider clinic as well as Ambulatory Surgery Centers (ASC) and in addition hospital professional services. Maintains a thorough understanding of National Correct Coding Initiative (NCCI) edits and relative value units as appropriate for the role. Understands and supports the Medicare and Commercial Carrier workflows related to daily coding and denial review and appeals management, including the preparation of supporting documents and information to support the appeal process. Monitors and validates physician charge capture. Self-motivated with the ability to work independently, multi-task, problem solve and make informed and accurate recommendations to medical professionals based on current information. Participates in coding team meetings and serves as a subject matter expert. Reviews medical documentation from physicians and other healthcare providers; assigns modifiers, diagnostic and procedure codes for symptoms, diseases, injuries, surgeries and treatments according to official classification systems and standards. Uses relevant policies, procedures, and individual judgment to determine whether events or processes comply with laws, regulations, or standards. Provide accurate and timely international classification of disease – tenth edition – clinical modification (ICD-10) - CM coding of diagnoses, Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) coding, and in accordance with official coding standards, regulatory coding compliance guidelines and company procedures. Review and audit medical record documentation accurately to reflect healthcare coding and to substantiate appropriate service reimbursement. Conveying coding guidelines to physicians and other healthcare providers to improve the accuracy of medical record documentation. Computer skills, the ability to interpret, analyze and abstract data/documentation, have good problem-solving skills, be self-motivated and have good time management and organizational skills.

Requirements

Associate degree in Health Information Technology or Certification in Coding required.
Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Professional Coder (CPC), Certified Professional Coder-Apprentice (CPC-A), Certified Coding Specialist (CCS), Certified Coding Specialist-Physician based (CCS-P), CCS Healthcare (CCS-H), Certified Outpatient Coder (COC) required.
If the associate is not certified at hire, the associate must be so within one year of the date of hire.
Strong problem-solving skills.
Effective communication with medical professionals.
Ability to work independently.
Ability to interpret, analyze and abstract data/documentation.
Good problem-solving skills.
Self-motivated.
Good time management and organizational skills.

Nice To Haves

Specific knowledge of diagnostic and procedural terminology.
Successful coursework from an accredited institution in International Statistical Classification of Diseases (ICD) diagnosis, Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) coding schemes, medical terminology or human anatomy/physiology is preferred.

Responsibilities

Review medical documentation, assign appropriate codes (ICD-10, HCPCS, CPT), and ensure compliance with coding standards, regulations, and company procedures.
Serve as a resource for providers in understanding covered indications and the supporting documentation.
Support both technical and professional services in provider clinic as well as Ambulatory Surgery Centers (ASC) and in addition hospital professional services.
Maintain a thorough understanding of National Correct Coding Initiative (NCCI) edits and relative value units as appropriate for the role.
Understand and support the Medicare and Commercial Carrier workflows related to daily coding and denial review and appeals management, including the preparation of supporting documents and information to support the appeal process.
Monitor and validate physician charge capture.
Participate in coding team meetings and serve as a subject matter expert.
Review medical documentation from physicians and other healthcare providers; assign modifiers, diagnostic and procedure codes for symptoms, diseases, injuries, surgeries and treatments according to official classification systems and standards.
Use relevant policies, procedures, and individual judgment to determine whether events or processes comply with laws, regulations, or standards.
Provide accurate and timely international classification of disease – tenth edition – clinical modification (ICD-10) - CM coding of diagnoses, Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) coding, and in accordance with official coding standards, regulatory coding compliance guidelines and company procedures.
Review and audit medical record documentation accurately to reflect healthcare coding and to substantiate appropriate service reimbursement.
Convey coding guidelines to physicians and other healthcare providers to improve the accuracy of medical record documentation.