The Coder is responsible for identifying, analyzing and reporting documentation and coding areas of concern. Assists in the ongoing education of providers and professional billing staff as it relates to government and third-party payer correct coding and documentation requirements. Acts as a resource for the Billing Department. Works towards improving the accuracy of medical records coding and documentation.
• Conduct independent reviews of current CPT and ICD codes selected by coders and providers for medical necessity and documentation requirements.
• Develop and implement an auditing process by creating internal reports and procedures.
• Review, analyze and report on note/documentation/coding results. Identify trends/patterns and communicate patterns and recommended corrective actions.
• Assist in the training of billing staff and providers related to third party payer documentation, coding requirements and improvement in the payment of claims.
• Assist in the evaluation of medical necessity, appropriateness and efficiency of the use of services related to commercial and federal coding or billing plans.
• Evaluate and assess coding and documentation practices of new physicians and clinical staff.
• Collaborate with the Revenue Cycle Director and Compliance Team as needed.
• Perform other office duties as assigned by Director.
• Associate’s degree in Medical Coding, Healthcare, Health Information Management or related field, plus one-year related experience, OR
• four (4) years related experience.
• Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA) or Certified Coding Assistant (CCA) or must be obtained within ten (10) months of hire.
• Must possess a proficient understanding of the Inpatient and Outpatient Prospective Payment Systems (IPPS\OPPS), Diagnostic and Statistical Manual of Mental Disorder (DSM - 5), and National Correct Coding Initiative Edits (NCCI), ICD- 10 CM Official Guidelines for Coding and Reporting and Coding Clinic.
• Working knowledge of relevant federal and state regulations, Medicaid/Medicare guidelines, and compliance issues.
• Advanced understanding of medical terminology, pharmacology, body systems/anatomy, physiology and concepts of disease.
• Experience with current ICD 10, CPT and HCPCS coding systems and other related documentation requirements.
• Demonstrated knowledge of, and skill in, data collection, statistical analysis, and/or interpretation.
• Demonstrated knowledge of, and skill in, oral communication, written communication, problem solving, analysis, project management, quality management, systems thinking, group presentations, group process facilitation, influence, and customer service.
• Demonstrated knowledge of and skill in word processing, spreadsheet, and database PC applications.
• Experience in health plan operations and an understanding of insurance claims processing desired.
• Ability to work effectively and professionally with all levels of employees.
• Ability to perform job duties with high degree of accuracy and timeliness in a fast-paced environment with competing priorities.
AspenPointe is an Equal Opportunity Employer regardless of age 40 and over, color, disability, gender identity, genetic information, military or veteran status, national origin, race, religion, sex, sexual orientation or any other applicable status protected by state or local law.