Description:
The Medical Coder will be responsible for accurately assigning diagnostic and procedure codes to patient encounters and medical services, ensuring compliance with coding guidelines and regulations. The ideal candidate will have strong knowledge of medical coding systems, such as ICD-10 and CPT, and experience in coding for OBGYN, laboratory, and mammography services.

Responsibilities:

• Coding and Abstracting: Review patient medical records, encounter forms, and other documentation to accurately assign diagnostic (ICD-10) and procedure (CPT/HCPCS) codes based on coding guidelines and documentation standards. Abstract relevant information from medical records, including diagnoses, procedures, treatments, and services rendered, to support accurate coding.
• Code Validation and Accuracy: Verify the accuracy and completeness of coded data, ensuring that codes assigned reflect the documented diagnoses, procedures, and services provided during patient encounters. Resolve coding discrepancies or inconsistencies by collaborating with healthcare providers, clinical staff, and other stakeholders to obtain additional information or clarification.
• Compliance and Documentation: Ensure compliance with coding guidelines, regulations, and payer policies, including but not limited to CMS guidelines, NCCI edits, and local coverage determinations (LCDs). Maintain up-to-date knowledge of coding updates, changes, and revisions, and apply coding updates appropriately to ensure accurate coding practices.
• Quality Assurance and Auditing: Perform regular audits and quality checks of coded data to identify coding errors, discrepancies, and opportunities for improvement. Assist with internal coding audits, external coding reviews, and compliance audits to ensure coding accuracy and adherence to regulatory requirements.
• KPI Requirements: Meet or exceed Key Performance Indicators to include 95% or above coding accuracy, 48 hour timely charge entry and claim edit/denial reconciliation rate, and 120-150 charts per day productivity, depending on chart complexity.
• Coding Education and Training: Provide coding education and training to healthcare providers, clinical staff, and administrative staff on coding guidelines, documentation requirements, and best practices for accurate coding. Assist with developing and implementing coding-related policies, procedures, and protocols to support coding compliance and accuracy.
• Collaboration and Communication: Collaborate with billing staff, revenue cycle management team members, and healthcare providers to resolve coding-related issues, denials, and reimbursement discrepancies. Communicate effectively with internal and external stakeholders regarding coding-related inquiries, coding updates, and documentation requirements.

Requirements:

• Certification as a Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) required.
• Minimum of 2-3 years of experience in medical coding, preferably in an OBGYN, laboratory, mammography or women’s health practice setting.
• Strong knowledge of medical coding systems, including ICD-10, CPT, and HCPCS, and coding guidelines and regulations.
• Proficiency in using coding software and electronic health records (EHR) systems for coding and documentation.
• Excellent attention to detail, analytical skills, and problem-solving abilities in reviewing and assigning diagnostic and procedure codes.
• Strong communication and interpersonal skills, with the ability to collaborate effectively with healthcare providers, clinical staff, and administrative staff.
• Commitment to maintaining coding accuracy, compliance with coding guidelines, and confidentiality of patient health information.

• Coding and Abstracting: Review patient medical records, encounter forms, and other documentation to accurately assign diagnostic (ICD-10) and procedure (CPT/HCPCS) codes based on coding guidelines and documentation standards. Abstract relevant information from medical records, including diagnoses, procedures, treatments, and services rendered, to support accurate coding.
• Code Validation and Accuracy: Verify the accuracy and completeness of coded data, ensuring that codes assigned reflect the documented diagnoses, procedures, and services provided during patient encounters. Resolve coding discrepancies or inconsistencies by collaborating with healthcare providers, clinical staff, and other stakeholders to obtain additional information or clarification.
• Compliance and Documentation: Ensure compliance with coding guidelines, regulations, and payer policies, including but not limited to CMS guidelines, NCCI edits, and local coverage determinations (LCDs). Maintain up-to-date knowledge of coding updates, changes, and revisions, and apply coding updates appropriately to ensure accurate coding practices.
• Quality Assurance and Auditing: Perform regular audits and quality checks of coded data to identify coding errors, discrepancies, and opportunities for improvement. Assist with internal coding audits, external coding reviews, and compliance audits to ensure coding accuracy and adherence to regulatory requirements.
• KPI Requirements: Meet or exceed Key Performance Indicators to include 95% or above coding accuracy, 48 hour timely charge entry and claim edit/denial reconciliation rate, and 120-150 charts per day productivity, depending on chart complexity.
• Coding Education and Training: Provide coding education and training to healthcare providers, clinical staff, and administrative staff on coding guidelines, documentation requirements, and best practices for accurate coding. Assist with developing and implementing coding-related policies, procedures, and protocols to support coding compliance and accuracy.
• Collaboration and Communication: Collaborate with billing staff, revenue cycle management team members, and healthcare providers to resolve coding-related issues, denials, and reimbursement discrepancies. Communicate effectively with internal and external stakeholders regarding coding-related inquiries, coding updates, and documentation requirements