Medical Coder II

SUMMARY:

The Level 2 Certified Medical Coder is responsible for documentation improvement and integrity and serves as a liaison between clinical care providers, finance, and billers. This role is also an information and educational resource, providing proactive and retrospective review of health center visits as they relate to ICD-10-CM diagnosis coding and reimbursement. The Level 2 Certified Medical Coder will audit medical records to ensure completeness, accuracy and compliance with Medicaid coding and supporting documentation guidelines.

QUALIFICATIONS:

• Certified Professional Coder (CPC) certificate or equivalent required.
• 2 - 5 years' experience in medical setting.
• Experience with computer systems required, including EMR, web-based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access.

Preferred Qualifications:

• Associate's degree preferred
• Certified Risk Coder (CRC) certificate referred
• Experience/Education in ICD-9/ICD-10 Coding. HCC or DxCG coding experience.
• Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications.
• Experienced communicating with providers.
• Experienced with finance and billing systems.

SPECIAL REQUIREMENTS:

The essential duties of this position present risk of exposure to airborne infection, body fluids, and blood-borne pathogen. Annual BBP Training is required.

Up to date immunization and annual TB testing is required. Hepatitis B vaccine and annual flu immunization are strongly recommended. All necessary vaccines are available at no charge at the health center. A Declination form must be signed if the Hepatitis B or other recommended vaccines are declined.

Results of inquiry to Criminal Offender Record Investigation (CORI) must be acceptable under health center standards.

SPECIFIC DUTIES AND RESPONSIBILITIES:

Evaluates medical record documentation for completion to ensure accuracy and compliance to meet Medicaid and ICD-10-CM standards.

• Compares past and present medical history of each participant to maintain complete and accurate ICD-10 codes for appropriate reimbursement.
• Reviews medical records prospectively to ensure that the care of the patient is recorded in language that payers can interpret which accurately and completely depicts acuity of the patient and resources expended.
• In close collaboration with the billing team, reviews medical records retrospectively, to ensure that accurate ICD-10 codes were selected by the provider.
• All methods adhere to coding compliance guidelines.

Serves as a resource for clinical teams to address risk adjustment and medical coding guidelines and updates.