Coder

GENERAL DESCRIPTION:

Serves in all administrative duties and financially related matters in the position Coding and billing out claims. Primary responsibilities are to ensure that all third parties billing is processed timely and accurately to expedite reimbursement, and to review all claim edits. The coder must review all third-party billing updates and bulletins and make certain that any billing changes are implemented immediately.

DUTIES & RESPONSIBILITIES:

Direct Service

• Audits medical records to ensure documentation supports what is coded.
• Research issues related to coding and payor requirements
• Reports quality issues to Providers and Management
• Providers coding and documentation training to staff and Providers.
• Reviews fee schedule to recommend changes.
• Reports quality issues to Providers and Management.

ESSENTIAL JOB REWUIREMENTS:

• Enter appropriate up-to-date information in the computer billing system and Routing sheet.
• Update fee schedule.
• Review regularly all bulletins and correspondence from carriers for up-to-date changes and keep for easy reference.
• Adhere to all billing requirements of Medicare, Medicaid, managed care plans, commercial carriers, Workers’ Compensation and other government programs.
• Assist in educating physicians and staff in requirements of documentation for proper reimbursement.
• Knowledge of basic business office equipment, computer, copier, calculator, telephone, and etc.
• Thorough knowledge of physician’s current procedural terminology that consists of five-digit numeric codes used to describe medical procedures, surgical procedures, radiology, laboratory, anesthesia and evaluation and management (E/M) service procedural Terminology (MOST CURRENT EDITION) for third party billing and of International Classification of Diseases Clinical Modification (ICD10-CM).
• Familiarity with common business and health care insurance/provider terminology.
• Ability to utilize basic mathematical skills, adding, subtracting, multiplying, computing percentages and decimals.
• Ability to establish and maintain effective working relationships.
• Ability to work independently within established system, policies, and procedures to organize work and to set priorities to accomplish multiple tasks within a given time frame.
• Ability to accept and respond to change in the work environment in a way that promotes organizational goals and objectives.
• Updates encounter forms as needed.
• Other responsibilities and tasks as assigned.

Qualifications

• Education – High School graduate or equivalent, Certification preferred
• Experience – Two years experience in a primary healthcare provider facility with third party billing and coding required. Other combinations of additional training and relevant experience may be considered. Ability to type at a rate of 40 words per minute.