Senior Medical Coder

Primary Responsibilities

• Codes a variety of medical records using CPT, HCPCS and ICD-10 codes for office, outpatient, inpatient, surgical, hospital ancillary, nursing facility, urgent care, ambulatory surgery center and other charges for physicians and other providers of professional billing
• Prepares, reviews, and transmits claims using billing software, including electronic and paper claim processing
• Contacts providers or their representatives regarding inappropriate, incomplete or unclear coding
• Searches for information in cases where the coding is complex or unusual. Forwards unresolved coding questions to manager for review and comment
• Ensures codes are accurate and sequenced correctly in accordance with government and insurance regulations
• Works directly with the auditors on coding documentation errors and payor updates. Communicates back to the team when appropriate
• Works with manager on workload to ensure month end completion and accuracy
• Follows up on outstanding coding related receivables following standard Revenue Operations policy/procedure/process and based upon payer filing deadlines
• Initiates refunds when appropriate for all third-party insurance receipts in accordance with governmental and insurance contract agreements
• Ensures appropriateness of payer rejections and denials for coding related reasons
• Contacts payers/governmental agencies regarding coding related denials and appeals as appropriate following established Revenue Operations policy/procedure/process
• Notifies manager of any coding denial trends
• Responds to coding related inquiries from providers and support staff and others as requested
• Maintains current of governmental and other payor coding and reimbursement rules and requirements
• Ensures compliance with payer filing deadlines
• Cooperates fully with all governmental and third-party insurer audits
• Adheres to all governmental and third-party compliance issues as directed
• Complies with health and safety requirements and with regulatory agencies such as DPH, etc.
• Complies with established departmental policies, procedures, and objectives
• Enhances professional growth and development through educational programs, webinars, etc.
• Performs other similar and related duties as required or directed

Required Qualifications

• High School Diploma/GED or equivalent experience
• Certified Coder: CPC, CCS-P, CCS, CPC-H
• Medical terminology certificate or demonstrated knowledge
• 2+ years of coding work experience
• 6+ months of experience and proficiency in current billing software
• Intermediate level of knowledge and experience in ICD-10, CPT and HCPCS coding or successful completion of related college courses
• Demonstrated knowledge of third-party billing
• Ability to work independently and as part of a team
• Ability to demonstrate a professional and courteous manner when interacting with physicians/providers, clinical department staff and co-workers
• Excellent organizational and communication skills