Coder, Provider Practice (Primary Care/Rural Health)

About the role

Serve as a resource for providers in understanding covered indications and the supporting documentation. Support both technical and professional services in provider clinics, Ambulatory Surgery Centers (ASC), and hospital professional services. Maintain a thorough understanding of National Correct Coding Initiative (NCCI) edits and relative value units. Understand and support Medicare and Commercial Carrier workflows related to daily coding, denial review, and appeals management, including preparation of supporting documents. 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 compliance with laws, regulations, or standards. Provide accurate and timely ICD-10‑CM coding of diagnoses, HCPCS and CPT coding in accordance with official coding standards, regulatory coding compliance guidelines, and company procedures. Review and audit medical record documentation to reflect healthcare coding and substantiate appropriate service reimbursement. Convey coding guidelines to physicians and other healthcare providers to improve the accuracy of medical record documentation. Facility: Remote SD (Central Time); Location: Remote, SD.

Responsibilities

• Serve as a resource for providers in understanding covered indications and supporting documentation.
• Support technical and professional services in provider clinics, ASCs, and hospital professional services.
• Maintain a thorough understanding of NCCI edits and relative value units.
• Understand and support Medicare and Commercial Carrier workflows related to daily coding, denial review, and appeals management, including preparation of supporting documents.
• Monitor and validate physician charge capture.
• Work independently, multi‑task, problem solve, and make informed, accurate recommendations to medical professionals based on current information.
• 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 compliance with laws, regulations, or standards.
• Provide accurate and timely ICD‑10‑CM coding of diagnoses, HCPCS and CPT coding in accordance with official coding standards, regulatory coding compliance guidelines, and company procedures.
• Review and audit medical record documentation to reflect healthcare coding and substantiate appropriate service reimbursement.
• Convey coding guidelines to physicians and other healthcare providers to improve the accuracy of medical record documentation.

Requirements

Associate degree in Health Information Technology or Certification in Coding required. Specific knowledge of diagnostic and procedural terminology, successful coursework from an accredited institution in ICD diagnosis, CPT, and HCPCS coding schemes, medical terminology or human anatomy/physiology is preferred.

Qualifications

• 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)
• If the associate is not certified at hire, certification must be obtained within one year of the date of hire.

Skills

• Computer skills
• Ability to interpret, analyze, and abstract data/documentation
• Good problem‑solving skills
• Self‑motivated
• Good time management and organizational skills

Benefits

Sanford offers an attractive benefits package for qualifying full‑time and part‑time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home‑work balance. For more information about Total Rewards, visit https://sanfordcareers.com/benefits.

Pay

Salary Range: $20.50 - $33.00 per hour.

Schedule

Shift: 8 Hours - Day Shifts; Job Schedule: Full time; Weekly Hours: 40.00; Remote work with flexible schedule.