HIM Cert Coder OP

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The HIM Certified Coder is responsible for accurate and timely coding of hospital inpatient, hospital outpatient, and/or professional fee encounters using appropriate ICD-10/ICD-PCS, CPT, or HCPCS codes, along with coding software such as computer-assisted coding and encoders. This ensures compliant billing of Carle claims. The HIM Certified Coder must understand and apply all regulatory coding guidelines, including National and Local Coverage Determinations, and CPT modifiers. They are also responsible for applying coding knowledge to resolve billing edits related to coding. The coder uses Carle electronic medical record systems to review clinical encounters.

Responsibilities

• Accurately code all records according to the appropriate coding classification system (ICD-10, CPT, HCPCS, and modifiers). The assigned codes should accurately reflect the diagnoses and procedures pertinent to the patient.
• Provide interdepartmental coding assistance as needed to ensure accurate coding assignment.
• Develop methodologies to ensure a coding process compliant with regulatory agencies, utilizing reference materials such as CMS publications, Coding Clinic, CPT Assistant, etc.
• Optimize revenue while maintaining compliance through activities such as auditing, monitoring, training, facilitating charges via the claim scrubber system, assisting with patient or payor inquiries, and researching coding/billing topics.
• Serve as an expert resource on CPT, HCPCS, ICD-10-CM, and other coding systems, as well as regulatory guidelines, for internal and external parties.
• Act as a liaison for coding and billing staff to ensure accurate charge capture.
• Report documentation and coding improvement needs based on review findings.
• Maintain coding certification, knowledge, and skills to perform job duties effectively.
• Perform provider and peer coding audits as requested.
• Assist in monitoring internal controls for coding and billing.
• Facilitate external audit activities and report findings to appropriate personnel.

Certifications: Certified Inpatient Coder (CIC), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Coding Specialist - Physician-Based (CCS-P), Certified Outpatient Coder (COC), Certified Professional Coder (CPC) all from respective professional organizations.

Seniority level

• Mid-Senior level

Employment type

• Full-time

Job function

• Health Care Provider

Industries

• Public Health

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