Coder - Clinic

Avera•Sioux Falls, SD

2d•Onsite

About The Position

The Coder is responsible for the daily coding and billing operations of assigned clinics. The role assigns appropriate CPT, ICD-10, and HCPCS codes to charges in accordance with national and payer guidelines and physician direction. The Coder works with physicians and clinic management to resolve coding, reimbursement, and patient concerns; communicates coding updates; and coordinates or completes insurance appeals for claims denied because of coding issues. The position also supports clinic charge-document design and maintenance, helps maximize third-party reimbursement, investigates reimbursement developments, reviews insurance bulletins, and provides clinic support during increased workloads, transitions, or as needed. The role requires effective communication, visual acuity sufficient to perform duties, the ability to hear and distinguish speech and other sounds, confidentiality, teamwork, and compliance with applicable safety and regulatory standards. Reasonable accommodations may be made where they do not cause undue hardship. The position is located at Avera Downtown Building in Sioux Falls and is listed as a regular day-shift role. The stated pay range is $21.75–$31.25, with the actual rate dependent on experience. Benefits for qualifying employees include PTO available on day one for eligible hires, up to a 5% employer retirement matching contribution, and career development through hands-on training and mentorship.

Requirements

Associate degree in Coding or Health Information Management, and/or 1–2 years of relevant experience, and/or current certification as a coding specialist.
1–3 years of coding or patient account experience, or the outlined degree or certification.
Within one year, AHIMA membership or one of the following credentials: Certified Coding Specialist (CCS), Certified Professional Coder (CPC), or Registered Health Information Technician (RHIT).
Ability to work the specified hours.
Visual acuity adequate to perform the position duties.
Ability to communicate effectively and to hear, understand, and distinguish speech and other sounds.
Ability to perform each essential job function satisfactorily.
Commitment to Avera’s mission, vision, core values, and social principles; promote compassion, hospitality, and stewardship.
Uphold Avera’s Communication, Attitude, Responsiveness, and Engagement (CARE) standards.
Work effectively in a team environment and maintain a productive and efficient workplace.

Responsibilities

Assign appropriate CPT, ICD-10, and HCPCS codes to charges according to national and payer guidelines and physician direction.
Work with physicians and clinic management staff to resolve coding, reimbursement, and patient concerns.
Communicate coding updates and changes to appropriate individuals.
Coordinate and/or complete insurance appeals for claims denied due to coding issues.
Assist in designing clinic charge documents and maintain them with current coding information.
Support maximum third-party reimbursement through financial planning, familiarity with payer contracts, and pursuit of appropriate reimbursement on claims.
Investigate and report current third-party payer reimbursement developments when issues or remittances cannot be resolved.
Review insurance bulletins and refer relevant information to other personnel as appropriate.
Provide support to clinics during increased workload, transitions, or as needed.
Maintain confidentiality and coordinate workflow effectively with team members.
Comply with applicable safety principles, laws, regulations, and standards, including CMS, The Joint Commission, DHHS, and OSHA where applicable.