Medical Coder II

POSITION SUMMARY:

The entry level 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 entry level Medical Coder will audit medical records to ensure completeness, accuracy and compliance with Medicaid coding and supporting documentation guidelines.

KEY RESPONSIBILITES:

• 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.
• Communicates and addresses documentation issues and variances nursing staff, physicians and mid-level practitioners.
• Maintains a continuous presence with clinical teams to foster trust, collaborative relationships, and culture of improvement.
• Reviews bulletins, AAPC website, and periodicals, and attends workshops to stay abreast of current issues and changes in the laws and regulations governing medical coding and proper documentation.
• Develops capability for Lean thinking and scientific problem-solving.
• Maintains and improves upon effective and accurate IS systems for managing, tracking, and analyzing annual diagnoses capture rates and overall coding quality.

QUALIFICATIONS:

History of good attendance and positive work attitude

Required Qualifications:

• High school diploma or GED required.
• Completion of medical coding program preferred.
• 1-3 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:

• 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.