IL - Medical Coder

Job Title: Medical Coder

Open to remote staff

POSITION SUMMARY

The Medical Coder is responsible for accurately assigning diagnostic and procedural codes across multiple service lines of the hospital complex, including inpatient acute, emergency, ICU, surgery, outpatient, physician clinic, swing-bed/skilled nursing, assisted living, specialty clinics, and therapy/diagnostics. This role ensures compliant, complete, and timely coding to support accurate claim submission, appropriate reimbursement, and regulatory compliance for a Critical Access Hospital.

ESSENTIAL FUNCTIONS

1. Assign ICD-10-CM, ICD-10-PCS, CPT, and HCPCS codes to inpatient, outpatient, emergency, surgical, and clinic encounters based on clinical documentation.
2. Code across all service lines, including acute inpatient, swing bed, SNF, ER, observation, outpatient surgery, physician clinic (professional services), therapy, and diagnostics.
3. Apply appropriate revenue codes, modifiers, and occurrence/value/condition codes for UB-04 and CMS-1500 claim types.
4. Ensure coding accuracy and compliance with CMS guidelines, Official Coding Guidelines, LCD/NCD policies, and CAH-specific reimbursement rules.
5. Abstract and enter coded data into TruBridge in a timely manner to support claim billing and productivity benchmarks.
6. Query providers as needed to clarify documentation for accurate and complete code assignment.
7. Identify and communicate clinical documentation deficiencies to clinical staff and leadership.
8. Stay current on annual ICD-10, CPT, and HCPCS code updates and payer coding policy changes.
9. Support coding audits, compliance reviews, and CAH cost report-related data integrity initiatives.
10. Collaborate with billing staff to resolve coding-related claim edits, rejections, and denials.

NON-ESSENTIAL FUNCTIONS

• Perform other duties as assigned by the Director, CBO or HIM Manager.
• Participate in facility committees or coding/compliance workgroups as requested.

MINIMUM QUALIFICATIONS

Education:

• High school diploma or equivalent required
• Completion of an accredited medical coding program or equivalent post-secondary coding education preferred

Experience:

• Minimum 2 years of medical coding experience
• Critical Access Hospital, community hospital, or multi-service line experience strongly preferred

Knowledge, Skills, and Abilities:

• Proficiency in ICD-10-CM/PCS, CPT, HCPCS, and revenue coding
• Familiarity with DRG, APC, and CAH cost-based reimbursement methodologies
• Knowledge of UB-04 and CMS-1500 claim formats
• Experience working in TruBridge or comparable community hospital EHR/PM system preferred
• Strong attention to detail, analytical skills, and ability to meet productivity standards

PREFERRED QUALIFICATIONS

• Associate's degree or higher in Health Information Management or a related field
• Experience with swing bed and skilled nursing facility coding

LICENSES AND CERTIFICATIONS

• Required or strongly preferred: CPC (Certified Professional Coder), CCS (Certified Coding Specialist), CIC (Certified Inpatient Coder), COC (Certified Outpatient Coder), RHIT, or CAH-CBS (Critical Access Hospital Coding and Billing Specialist)

Physical Requirements:

The physical demands described below are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Constantly (67-100% of the time): Sitting, Talking/ Hearing, Near Visual Acuity
• Frequently (34-66% of the time): Repetitive Hand/ Wrist Motion
• Occasionally (11-33% of the time):Walking, Standing
• Rarely (less than 10% of the time): Bending/Stooping, lifting/carrying (up to 25 lbs)

WORK ENVIRONMENT

Work is performed in a professional administrative/office environment within a healthcare facility. The employee may work in proximity to patient care areas. Standard office lighting, temperature, and noise levels apply. Occasional movement between departments and buildings within the hospital complex may be required. Remote or hybrid work arrangements may be considered based on organizational policy and performance.