Coder, ProFee

Duties and Responsibilities:

• Assigns ICD-10-CM codes, and CPT/HCPCS codes for various specialty service accounts, including but not limited to diagnoses, provider level evaluation & management (E/M) charges, and additional CPT-4 procedures.

• Abstracts key data elements required for billing, regulatory agencies, and other databases.

• Reviews records for clinical pertinence and documentation to support accurate facility and provider-based charges for services performed during the encounter.

• Communicates with providers for clarification of documentation to ensure appropriate assignment of diagnoses, procedures, and/or facility and provider evaluation/management (E/M) levels.

• Reviews and resolves claim edits related to emergency department encounters to ensure compliant billing, including but not limited to medical necessity and NCCI/CCI edits.

• Assists with resolution of simple visit coding errors related to other outpatient visits as needed.

• Demonstrates courtesy and professionalism through interaction, appearance, attitude, and written and oral communications with visitors, co-workers, physicians, and other hospital personnel as to represent the Medical Records Services as a high-quality service area of the Hospitals.

• Maintains patient confidentiality as required by Hospitals/departmental policy and industry/legal standards.

• Acknowledges and supports Hospitals defined goals and approach to patient care; attends regular training sessions to improve patient and customer communications.

Knowledge, Skills, and Abilities:

• Skill in prioritizing and performing a variety of duties within a system that has frequently changing assignments, priorities, and deadlines.

• Ability to impart knowledge of procedures and techniques.

• Thorough working knowledge of ICD-10-CM and CPT coding systems, and federal/state regulations regarding reimbursement.

• Thorough working knowledge of the hospital information system, electronic medical record systems, and encoder.

• Working knowledge of standards for chart completion.

• Maintains Continuing Education credits in accordance with the American Health Information Management Association's and/or American Academy of Professional Coders’ requirements based upon certification(s).

• Performs qualitative analysis of records in accordance with regulatory standards and coding requirements using CPT/HCPCS and ICD-10-CM guidelines.

• Working knowledge of medical-legal rules and regulations that govern the confidentiality and release of medical information with the ability to interpret and implement the standards.

• Must maintain total confidentiality of all patient records.

• Must be comfortable working with AR teams to resolve issues.

• Must be able to pass a coding assessment.  

• Must be proficient in Microsoft Office, including Outlook, Excel, and Teams.

• Ability to multi-task and have excellent communication skills.

• Must meet and maintain a 95% quality accuracy rate and productivity standards.  

• Must have experience working in a remote environment.