Job Description – Coder
Position Title – Coding Executive/Medical Coder
Position Reporting To – Coding Manager
Position Objectives –
1. Apply diagnostic & procedural codes to individual patient individual health data for claims processing and ensure the claims are paid by payers.
2. Review denials for coding lapses and suggest corrective and preventive actions.
Position Responsibilities –
1. Thorough understanding of the contents of medical record in order to identify information to support coding.
2. Basic knowledge of anatomy & physiology of human body and diseases in order to understand etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and procedures to be coded.
3. Basic understanding of claims form and reimbursement process.
4. Abstracts pertinent information from patient medical records. Assigns ICD-9-CM, CPT/HCPCS codes, and modifiers.
5. Reviews and analyzes medical records to identify relevant diagnoses and procedures for distinct patient encounters.
6. Translates/abstracts diagnostic and procedural phrases into coded form – the accurate translation process requires understanding & interpretation of medical reports, industry standard and payer specific coding conventions and guidelines. Understanding of local medical policies of carriers and Medicare’s correct.
7. Reviews denials for coding lapses and suggests coding changes for corrective and preventive (root cause) action by DHT (denial handling team) team.
8. Actively reviews denials and researches to create claims scrubber edit which will prevent specific coding denials permanently.
9. Notifies Coding Manager/Account Manager or designated individual when reports are incomplete and code assignments are not straightforward or documentation is inadequate and updates relevant logs.
10. Keeps self updated of coding guidelines and federal reimbursement requirements, actively participates in and contributes to coding team presentations on Advance/Refresher Coding topics
11. Abides by Standards of ethical coding as set forth by American Academy of Professional Coders (AAPC) and American Health Information Management Association (AHIMA) and adheres to official coding guidelines.
Position Qualifications –
Must be a graduate, preferably in Life Science, with basic training in medical transcription or medical coding, or coding certificate program with AAPC certification status (CPC) preferred. Certification is not essential.
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