Medical Coder

About This Role

The Medical Coder is responsible for the day-to-day coding and billing operations for all services billable under grants, federal, state, and county programs, including Medicare, Medicaid managed care, and private insurances. This position is eligible for remote work following completion of required onsite training, but candidates must reside in Washington State to participate in training and attend occasional in-person meetings as needed.

Responsibilities

• Review and adjudicate coding of services from documentation in a timely manner
• Maintain physician/provider visit procedure codes and notes to identify appropriate ICD-10 and CPT codes for charge processing
• Ensure that all diagnosis ICD-10 codes, procedure CPT codes, and HCPCS codes are identified, sequenced, and coded in an accurate and ethical manner for optimized reimbursement
• Assign Evaluation and Management codes and key concepts/elements documented in the patient notes, utilizing defined coding guidelines applicable to professional and technical standards
• Research and identify correct codes for routine, and/or new or unusual diagnosis and procedures not clearly listed in ICD-10 and CPT guidelines and functions of the position
• Identify all procedures that may require modifiers (including 340B) for billing and reporting
• Consult with providers for clarification of clinical data when encountering conflicting or ambiguous information and/or significant missing documentation
• Track cases with insufficient documentation, ensuring the case is appropriately coded and billed
• Ensure documentation adheres to federal, state, and county billing policies
• Adhere to attendance standards in order to perform the job functions for daily operations and/or continuity of patient care

Requirements

• Reads, speaks, understands, and writes proficiently in English
• Effectively communicates orally and in writing
• Represents the organization in a professional and effective manner to the community
• Remains calm and effective in high-pressure and emergency situations
• Works with initiative, energy, and effectiveness in a fast-paced environment
• Produces work in high quantity and quality
• Problem-solves with creativity and ingenuity
• Knowledge of medical terminology
• Knowledge of HIPAA regulations and compliance
• Ability to make decisions regarding sensitive information
• Comprehensive knowledge and understanding of medical coding
• Proficiency in the use of Microsoft Office applications: Word, Excel, and Outlook
• High School graduate or equivalent
• Certified Professional Coder (CPC) by the American Academy of Professional Coders (AAPC) or Coding Specialist (CCS) certified by the American Health Information Management Association (AHIMA)