Job Summary

Under direction of the Vice President of Clinical Quality and Coding, the Medical Coder/Auditor reviews clinical documentation for quality and to determine accuracy of claims billing records. The Medical Coder/Auditor is responsible for performing quality reviews of patient medical records to validate the integrity of ICD-10 diagnoses and procedures as well as CPT/CPT II coded procedures. The Medical Coder/Auditor reviews medical records and other documentation to identify under and over coded services, prepares reports of findings and meets with management to educate on and improve quality clinical documentation and coding practices. The Medical Coder/Auditor ensures appropriate and accurate coding of all documented conditions as reviewed within all compliant documentation. The Medical Coder/Auditor ensures that billing is accurate, and errors are minimized by identifying opportunities through audit and observation. The Medical Coder/Auditor remains abreast of regulatory and procedure changes which may affect coding compliance and /or reimbursement.

Essential Job Functions

· Supports and implements the organization’s vision, mission, and values

· Establishes priorities and method of completing daily workload to ensure that all responsibilities are carried out in a timely manner.

· Performs all job functions in a professional and courteous manner. This includes answering all general phone calls timely and providing excellent customer service to internal and external customers.

· Fosters and promotes a culture of service excellence and accountability

· Performs a comprehensive medical records review to assure the presence of all component parts including patient and record identification signatures, dates where required, and other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered.

· Reviews assigned ICD-10-CM codes, which most accurately describe each documented diagnosis and/ or procedure according to established ICD-10-CM and CPT coding guidelines

· Monitors all coding accuracy at various levels of detail and maintains coding quality as needed.

· Tracks coding issues and reviews coding inaccuracies to highlight areas of improvement. Reports or resolves escalated issues as necessary.

· Educate physicians and clinical staff to appropriate coding and/or documentation as required by medical review

· Provides a high level of technical education and serves as a subject matter specialist regarding coding and documentation

· Conduct periodic meetings with providers to include:

· Chart reviews for quality review and best practices for clinical documentation

· Coding reviews for over/under coding patterns to support accuracy and specificity

· Address over coding and/or under coding issues individually with physicians and other providers

· Participate in special audits as instructed.

· Work as a team member within the business office and all other departments.

· Document work processes as required

· Performs other duties as assigned.

Skills and Competencies

· AA degree or equivalent with three years Certified Professional Coder (CPC)

· Must demonstrate a clear understanding of medical terminology, Current Procedural Terminology (CPT) and International Classification of Disease (ICD) coding

· Ability to read and interpret documents, such as policies and procedures, benefits information, benefit surveys, board minutes, routine mail, simple contracts, and procedure manuals.

· Ability to compose routine reports and correspondence.

· Ability to make decisions and execute timely to produce positive outcome

· Must be comfortable educating providers

· Organizes and prioritizes work with minimum supervision.

· Manages time efficiently and follow through on duties to completion

· Performs most essential job duties independently and exercises good judgment

· Must be flexible and detail oriented

· Demonstrates required knowledge, skills, education for job functions

· Adheres to company’s policies and procedures

· Demonstrates knowledge of current compliance standards for federal, state, and local regulatory agencies.

· Demonstrates excellent communication skills, both oral and written.

· Demonstrates proficiency in computer applications such as Microsoft Excel, Power Point, Word, and Outlook

Education and Experience

· AA degree or equivalent with at least three years Certified Professional Coder (CPC) through the American Academy of Professional Coders (AAPC), or Certified Coding Specialist (CCS) through the American Health Information Management Association (AHIMA)

· Previous experience with medical record chart review

· Previous experience with HEDIS data abstraction

· Managed Care, Medicare experience a plus

· Certified Risk Adjustment Coder (CRC) certification a plus

· Certified Professional Medical Auditor (CPMA) a plus

· Clinical experience a plus (i.e., RN or MD)

Physical Demands

· Remote or work at home employees must have a dedicated workspace

· Must have appropriate internet access, desk, lighting, and ability to maintain privacy

· Maintain communication with department leader, other team members and leaders via Microsoft Teams and Zoom

· Adhere to all policies and procedures, including standards for safety, conduct and attendance

Additional Information

· Must abide by all HIPAA, Confidentiality & Privacy Laws

· Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.

DISCLAIMER:

Job descriptions are not meant to be all-inclusive and/or the job itself is subject to change. Nothing in this job description restricts ilumed’s right to assign or reassign duties and responsibilities to this job at any time.

Job Type: Full-time

Pay: $25.00 - $28.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee discount
• Health insurance
• Life insurance
• Paid time off
• Vision insurance
• Work from home

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Experience:

• Certified Professional Coder: 3 years (Required)

Work Location: Remote

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