The Coder III reviews clinical documentation and diagnostic results and assigns appropriate ICD-10-CM, ICD-10-PCS, CPT, modifier, and procedure codes to support diagnoses, procedures, treatment results, billing, reporting, research, and regulatory compliance.
Responsibilities include:
- Ensuring all ICD-10-CM and CPT codes are accurately captured
- Abstracting physician and encounter information correctly
- Staying current on coding guideline changes through education and meetings
- Participating in internal and external quality review activities
- Resolving billing-related errors and supporting workflow and process improvement efforts
- Assigning inpatient surgery codes, including principal diagnosis, comorbidities, complications, secondary conditions, and surgical procedures
- Abstracting required data elements, including discharge disposition and OSHPD-required information
- Assigning MS-DRG, APR-DRG, POA indicators, and identifying HAC conditions
- Querying physicians when documentation is unclear or conflicting
- Serving as a coding consultant and subject matter expert for provider and coding staff
- Completing charge review and claim edits in Epic or other EMR systems
- Reviewing and communicating with providers regarding E/M leveling and coding
- Coding specialty-specific outpatient surgeries and same-day procedures
This role supports both hospital and clinic coding functions within a large regional health system.
Requirements & Qualifications
High school diploma or equivalent required.
Required experience
- Completion of a certified coding program or graduate of a CAHIIM-accredited HIT program required for hospital coding
- Five years of progressive inpatient coding experience in an acute care facility
- For clinic coding, 5+ years of coding experience assigning diagnostic and procedure codes to patient records
- Extensive outpatient coding experience across multiple specialties
Required certifications
- CCS required for hospital coding
- For clinic coding, one or more of the following:
- CPC
- COC
- CCS-P
- CCS
- CPMA
- For Cath Lab/IR, one of the following:
- CPC
- CCS
- CIRCC
Preferred qualifications
- Multi-specialty CPT/ICD-10-CM coding experience, including OB/GYN, Urology, Oncology, Pain Management, Cardiology, Neurology, and Orthopedics
- Knowledge of E/M coding for multi-specialty providers
- Strong understanding of disease processes, pathology, and physiology
- Excellent interpersonal and communication skills
- Ability to work independently in a time-oriented environment
- Experience using Epic EMR
- CUC certification preferred for clinic coding
Location
California, US
Employment Type
Full-time
Experience Level
Senior
Remote work allowed
No
Posted
2 weeks ago
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