Reviews medical record documentation and assigns diagnosis, procedure, and modifier codes as applicable to support proper billing and compliance.
Communicates with insurance companies regarding coding errors and disputes, abstracts pertinent data for billing and quality reviews, and works with departments to maintain accurate patient data.
Conducts coding reviews and audits with healthcare professionals to ensure documentation accuracy.
Assigns basic CPT procedure codes and modifiers using coding guidelines, CMS regulations, Local Medical Review Policy guidance, encoder software, and department policies. Reviews APC, EAPG, and LCD edits and research medical records for additional diagnoses needed to support medical necessity.
Validates ADT field accuracy and reviews documentation for correct diagnosis, procedural, modifier, and HCC code assignment for hospital and physician billing workflows.
Works coding queues, resolves edits, makes corrections, seeks clarification when needed, and coordinates with billing staff to resolve charge entry or account issues.
Maintains coding knowledge, submits daily productivity reports, and meets quality and productivity standards.
High school diploma or equivalent required.
One year of hospital-based outpatient coding experience for HIM coder roles, or one year of diagnostic/procedural office coding experience with surgical coding experience for physician billing coder roles, or six months working within Memorial Health System.
Required certifications may include CCA, CCS, RHIA, or RHIT for HIM roles; CPC, CPMA, CRC, CCS, or CCSP for physician billing roles; or CCS, CCA, or CPC for hospital billing roles.
Strong knowledge of anatomy, physiology, medical terminology, and coding classification systems.
Ability to work independently with minimal supervision, use electronic medical record systems, and perform in a stressful environment.
Basic computer proficiency and effective communication skills required.
Location
Florida, US
Employment Type
Full-time
Experience Level
Entry Level
Remote work allowed
Yes
Posted
2 weeks ago