Medical Coder I

CLS Health PLLC•Webster, TX

About The Position

At CLS Health, we are redefining healthcare delivery. As Houston’s largest physician-owned, physician-led healthcare system, our mission is to provide patient-centered care through innovation and operational excellence. With over 200 providers in 35 locations and 40+ specialties, we’re building a scalable healthcare system that empowers physicians and delivers unmatched quality and access for patients. Summary Assigns and aligns predefined codes, tabulates the data into the computer system, generates new codes, resolves edits and denials, and maintains proper records in accordance with CLS guidance and procedures. Conducts regular reviews to ensure billing is timely, accurate, and in compliance. Job Description Assist with implementing and maintaining system-wide billing and coding quality audits. Understands, interprets and applies coding guidelines for coding audits. Review of medical records to determine coding accuracy of all documented diagnoses and procedures. Reviews claims to validate submitted codes and abstracted data including but not limited to ICD-10-CM codes, CPT’s, and HCPCS codes, which all impact reimbursement. Assure appropriateness and accurate of coding assignments in accordance with federal coding regulations and guidelines. Identifies documentation issues (lacking documentation, missed physician queries, etc.) that impact coding accuracy. Clearly communicates (verbally and in written reports or summaries) opportunities for documentation improvement related to coding issues. Stays current with AMA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM, CPT, and HCPCS coding. Completes online education courses and attends mandatory coding workshops and/or seminars (ICD-10-CM, HCPCS and CPT updates) for all specialties (e.g. OPPS, IPPS) coding. Reviews AMA, CMS ASC Payment System, and CPT quarterly coding update publications. Evaluate the effectiveness of internal controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements and guidelines related to professional and facility fee documentation, coding and billing, including CMS and OIG compliance standards. Review the EMR system to ascertain the accuracy of the physicians E/M, Diagnosis and Procedure coding based on their documentation and updating this information either in our reporting system or a spreadsheet. Review daily provider notes and work with Providers to ensure all notes meet documentation requirements. Performs additional duties as required or assigned

Requirements

High school diploma or equivalent; associate degree in Health Information Management or related field preferred.
Active coding certification such as: CPC, CPC-A (AAPC) CCA, CCS, CCS-P (AHIMA)
Knowledge of medical terminology, anatomy, and pathophysiology.
Experience working with EHR systems and encoder software.
Strong analytical skills and exceptional attention to detail.
1–3 years of professional coding experience in outpatient, inpatient, or professional coding.
Experience coding for specialties such as family medicine, emergency medicine, cardiology, orthopedics, or surgery.
Familiarity with risk adjustment/HCC coding (if applicable).
Knowledge of payer guidelines and claims processing workflows.

Responsibilities

Assist with implementing and maintaining system-wide billing and coding quality audits.
Understands, interprets and applies coding guidelines for coding audits.
Review of medical records to determine coding accuracy of all documented diagnoses and procedures.
Reviews claims to validate submitted codes and abstracted data including but not limited to ICD-10-CM codes, CPT’s, and HCPCS codes, which all impact reimbursement.
Assure appropriateness and accurate of coding assignments in accordance with federal coding regulations and guidelines.
Identifies documentation issues (lacking documentation, missed physician queries, etc.) that impact coding accuracy.
Clearly communicates (verbally and in written reports or summaries) opportunities for documentation improvement related to coding issues.
Stays current with AMA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM, CPT, and HCPCS coding.
Completes online education courses and attends mandatory coding workshops and/or seminars (ICD-10-CM, HCPCS and CPT updates) for all specialties (e.g. OPPS, IPPS) coding.
Reviews AMA, CMS ASC Payment System, and CPT quarterly coding update publications.
Evaluate the effectiveness of internal controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements and guidelines related to professional and facility fee documentation, coding and billing, including CMS and OIG compliance standards.
Review the EMR system to ascertain the accuracy of the physicians E/M, Diagnosis and Procedure coding based on their documentation and updating this information either in our reporting system or a spreadsheet.
Review daily provider notes and work with Providers to ensure all notes meet documentation requirements.
Performs additional duties as required or assigned