Medical Coder I

Summary

Assign predefined codes, tabulate data in the computer system, generate new codes, resolve edits and denials, and maintain proper records in accordance with CLS guidance and procedures. Conduct regular reviews to ensure billing is timely, accurate, and compliant.

Responsibilities

• Assist with implementing and maintaining system-wide billing and coding quality audits.
• Review medical records to determine coding accuracy for documented diagnoses and procedures.
• Review claims to validate submitted codes and abstracted data, including ICD-10-CM, CPT, and HCPCS codes.
• Ensure coding assignments are accurate and compliant with federal coding regulations and guidelines.
• Identify documentation issues that impact coding accuracy and communicate opportunities for documentation improvement.
• Stay current with AMA Official Coding and Reporting Guidelines, CMS directives, and quarterly coding updates.
• Evaluate internal controls related to professional and facility fee documentation, coding, and billing compliance.
• Review the EMR system for accuracy of E/M, diagnosis, and procedure coding.
• Review daily provider notes and work with providers to ensure documentation requirements are met.
• Perform additional duties as required or assigned.