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The HIM Coder/Biller is responsible for the accurate assignment of ICD-10-CM diagnosis codes and resolution of claim edits for outpatient records across the hospital.
Reports to
Facility Coding Manager
Job Specific Responsibilities
1. Assign accurate diagnosis codes for outpatient, ancillary laboratory, and diagnostic services.
2. Maintain current knowledge of coding guidelines, regulatory requirements, and medical billing processes.
3. Perform coding quality reviews and audits as assigned.
4. Troubleshoot and resolve SVC (Simple Visit Coding) errors while identifying process improvement opportunities to prevent billing delays.
5. Review and resolve claim edits and denials, identifying corrective actions and preventative measures to improve claim accuracy.
6. Collaborate with internal departments to support efficient revenue cycle operations and issue resolution.
7. All other duties as assigned by the coding manager.
Education and Experience
• High School Diploma or GED.
• Completion of Medical Record technology program or equivalent job experience.
• Experience with billing and clinical EMR software; Epic strongly preferred.
• Minimum of two (2) years of medical coding and billing experience preferred, including service areas such as Emergency Department, outpatient, ambulatory, surgery, observation, and clinic/series encounters.
Required Licensures/Certifications/Registrations
• RHIT, RHIA, CCS-P, CPC, or equivalent coding certificate.
Knowledge, Skills and Abilities
• Strong working knowledge of ICD-10-CM, CPT, HCPCS, and E/M coding guidelines.
• Understanding of medical claims processing and billing functions.
• Strong organizational and time management skills.
• Ability to prioritize tasks and meet deadlines.
• Ability to respond to ever-changing needs and situations.
• Strong attention to detail and commitment to accuracy.
• Ability to maintain strict confidentiality.
Interaction with Other Departments and Other Relationships
Works collaboratively with team members across Health Information Management (HIM), Patient Financial Services, Registration, Case Management, Revenue Integrity, and other Revenue Cycle departments.
Physical Capabilities
Occasionally exerts a small amount of force to lift, carry, push, pull, and move objects. Should be able to lift 10 lbs. Work involves sitting for prolonged periods of time. Hearing acuity is required to be able to accurately transact business dealings.
Environmental/Working Conditions
This position primarily operates in an indoor office environment with protection from weather conditions; however; occasional temperature variations within the facility may occur. Periodic travel to off-site locations may be required, and travel activities may be affected by weather conditions.
UMC Health System provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment on the basis of race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
*Request for accommodations in the hire process should be directed to UMC Human Resources.*
