HIM Coder - Professional
About The Position
Works under the supervision of the HIM Manager (Operations & Auditing). The primary function of the HIM Coder - Professional is to code and charge medical office visits for professional claims. Must be able to review and edit charges in Meditech as well as review leveling criteria for E/M charging accuracy, charge for procedures and other billable services provided in the clinic/office setting. Must be able to code ICD-10 diagnoses and CPT codes while ensuring they are assigned correctly and sequenced appropriately. Must apply HCC/risk coding concepts to ensure the appropriate risk score is assigned to each patient. Must understand the basic ICD-10 diagnosis and CPT procedure coding rules and guidelines. Performs other duties as assigned.
Requirements
- High School Diploma or successful completion of an equivalent High School Exam Required
- Successful completion of the HIM Coder - Professional/HCC competency exam within 6 months of hire required
- Successful completion of medical terminology course required
- Professional Coder certification (CPC, CCS-P, RHIA or RHIT) through AHIMA or AAPC by May 3, 2026 -or- within 1 year of hire required
- Two years of coding and charging experience required, -or- successful completion of an accredited coding course.
Nice To Haves
- Successful completion of an anatomy and physiology course preferred
- Successful completion of a formal coding training program preferred
- HCC/Risk Adjusted Coding experience preferred
Responsibilities
- Confirms, verifies and adds charges as necessary for reimbursable high dollar supplies and ensures that documentation supports the charges captured on professional claims.
- Determines sequence of diagnoses according to set guidelines for professional coding, including HCC coding guidelines and determines E/M level based on published criteria, accuracy of CPT procedure codes and other services provided in the professional office.
- Understands the human anatomy, physiology, pharmacology and medical terminology to assure coding and charging accuracy on professional claims.
- Assigns and abstracts codes from outpatient orders and electronic records to HDM after confirming the validity of the code in the code finder as well as reviewing confirmed test results for the most accurate code assignment.
- Assists with denial management of professional denial that are coding or charging related.
- Maintains productivity and quality standards as set per work type comparable to national averages and benchmarks.
- Maintains a passing score on the annual HIM 'professional' coding competency test at 80% or higher that includes HCC coding rules and guidelines.
- Assists in Meditech ambulatory registrations.
- Performs other duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Industry
Hospitals
Education Level
High school or GED
Number of Employees
501-1,000 employees
