Medical Coder

Radiant Digital•Cranston, RI

3d•Onsite

About The Position

The Medical Coder reviews and evaluates inpatient and outpatient medical health records to extract diagnostic, procedural, and demographic information. The role ensures accurate code assignment and maximizes financial reimbursement through interpretation and application of HCFA, ICD-10-CM, and CPT-4 rules and regulations, including correct selection and sequencing of diagnostic and procedural codes. The coder accurately abstracts information for financial, statistical, and billing databases and forwards coded records to the billing unit. Records are paper-based because the facility does not have electronic medical records. The position is based primarily in Cranston, Rhode Island, with some travel between Cranston and Zambarano Hospital. The schedule is Monday through Friday, 8:00 a.m. to 4:00 p.m., with a 30-minute lunch, for 35 hours per week. This is a one-year contract. The worker must use their own vehicle, hold a valid driver’s license, and provide proof of a CCS certificate from AHIMA or CPC certification through AAPC. Travel expenses are not reimbursed.

Requirements

Medical Coding certificate and ICD-10 certification are required.
Provide proof of CCS certification by AHIMA or CPC certification through AAPC.
Valid driver’s license and use of own vehicle are required; travel expenses are not reimbursed.
Extensive working knowledge of medical terminology, anatomy, physiology, pathology, pharmacology, diagnostic testing, and medical procedures sufficient to interpret medical records and determine diagnoses and procedures.
Complete working knowledge of ICD-10-CM and CPT-4 classification systems and proficiency in applying coding rules and regulations.
Knowledge of Medicare, Medicaid, and other third-party payor regulations and billing and reimbursement policies.
Ability to extract and assign appropriate codes for billing and to provide guidance and assistance to medical, medical records, and billing staff.
Education and experience such as a college graduation with specialization in medical record science, or graduation from a nursing school with CCS or CPC certification; alternatively, experience as a Coding Abstractor or Coding Specialist working with CPT-4 in the reimbursement area at an approved public or private hospital, or substantially equivalent education and experience.

Responsibilities

Review and evaluate inpatient and outpatient medical records and extract pertinent diagnostic, procedural, and demographic information.
Apply HCFA, ICD-10-CM, and CPT-4 rules and regulations to support accurate coding and financial reimbursement.
Select, sequence, and code diagnostic and procedural information accurately.
Bring questionable or poorly documented cases to the physician of record, Medical Records Director, or Medical Director for discussion, clarification, and resolution.
Collaborate with and provide coding-related assistance to medical staff and medical records staff.
Work with billing unit staff to ensure appropriate internal control of data.
Verify information on PSI abstract forms and review additional information recorded on those forms.
Use computer systems to determine health care coverage for each patient.
Ensure health care records are coded, abstracted, and forwarded to the billing unit for billing purposes.
Maintain a weekly status log of admissions, transfers, and discharges so records are accounted for and completed.
Maintain strict confidentiality of patient and hospital information.
Assist the supervisor and medical staff with other related work as requested.