Medical Coder Job Description

Medical Coder Job Description

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Medical coder provides documentation and coding audits of all billing providers within the practice based on documentation guidelines, Medicare Teaching Guidelines and NCCI coding initiatives.

Medical Coder Duties & Responsibilities

To write an effective medical coder job description, begin by listing detailed duties, responsibilities and expectations. We have included medical coder job description templates that you can modify and use.

Sample responsibilities for this position include:

Correspond or meet with providers to resolve abusive billing practices and to reach an appropriate financial settlement
Educate providers on plan policies and guidelines, medical necessity criteria, UM programs correct billing methods and procedure codes by written and verbal communication
Audit documentation to ensure it supports complete, accurate and compliant billing with both CMS and payer requirements
Assist practice physician and mangers with all coding errors, denials, or issues encountered in the billing process
Monitor charge review queues to ensure that all accounts flow through to billing appropriately
Submit all charges into billing system for claims processing
Act as liaison between billing company and the Perinatal Unit
Codes billing supplies and implants
Translate written policy interpretation into CPT, HCPC, ICD-9/ICD-10 codes for input into systems
Perform cost effective hospital and office audits that include a thorough and comprehensive review, analysis and documentation of findings in the complete medical records and the financial records

Medical Coder Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for Medical Coder

List any licenses or certifications required by the position: CCS, CPC, RHIT, RHIA, AHIMA, AAPC, HCS-D, ICD, CRC

Education for Medical Coder

Typically a job would require a certain level of education.

Employers hiring for the medical coder job most commonly would prefer for their future employee to have a relevant degree such as Associate and Bachelor's Degree in Medical, Healthcare, Health Information Management, Associates, Health, Education, Health Information Technology, Technical, Life Science, Nursing Program

Skills for Medical Coder

Desired skills for medical coder include:

Medical terminology
Complies with coding guidelines and reimbursement reporting requirements
Billing
Government regulations
Protocols and third-party requirements regarding coding
CPT/HCPCS and coding guidelines
Anatomy and physiology
Reimbursement systems
Revenue cycle management
Ancillary services

Desired experience for medical coder includes:

Monitor compliance with policies and procedures relevant to clinical data reviewed
Review the Physician's notes and ensure that the correct codes are used
Sends the physician notification of incorrect codes to amend the notes
Sign and submit the Super-Bill
Assist in the oversight of compliance programs and activities
Work closely with independent auditors and external exam teams to provide necessary support and materials necessary to test compliance programs and activities

Medical Coder Examples

1

Medical Coder Job Description

Job Description Example
Our company is growing rapidly and is looking for a medical coder. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for medical coder
  • Obtain prior authorizations from insurance companies in a timely manner for all hematology/oncology treatments and procedures
  • Monitor coding work queues for simple visit coding including rehabilitation services
  • Enter and/or review charges for provider services
  • Query physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes
  • Bring identified concerns to Supervisor or Department Manager for resolution
  • Abide by the standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines
  • Code information within the Inpatient Unit
  • Research coding issues
  • Communicate to supervisor any discrepancies, concerns, or questions
  • Code charts with highest attention to detail to avoid mistakes
Qualifications for medical coder
  • Reviewing medical procedures as documented by doctors
  • Alert physicians, technicians and physician assistants of any discrepancies in documentation
  • Consult with physicians concerning difficult to code cases or cases where the diagnosis is vague in order to be able to assign the correct coding nomenclature
  • Obtain insurance authorizations for additional services
  • Run report to ensure that all charges were captured and billed
  • Analyze payment report to ensure that reimbursement is according to contractual agreement and to identify short payments
2

Medical Coder Job Description

Job Description Example
Our company is growing rapidly and is looking for a medical coder. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for medical coder
  • Systematically review and analyze patient medical records to determine all appropriate diagnosis and procedures performed, and to produce coded abstract for physician billing
  • Submission of coded services for billing and or data entry of the coded services for claim submission in accordance with departmental productivity and accuracy standards
  • Code charge tickets for all surgical and non-surgical departments
  • Review and correct coded outpatient tickets
  • Code electronic chart documentation for medical wards and consultation services
  • Assists business office management with any special projects related to coding issues or questions that may include medical records audits and other coding/HIM support, as appropriate
  • Assists with preparation for accrediting bodies and/or State reviews
  • Practices and adheres to the Company’s Code of Conduct philosophy and its Mission and Values Statement
  • Conduct and document results of regularly scheduled audits of members
  • Oversee medical records for compliance with ICD-10 coding and CMS-HCC Risk Adjustment criteria
Qualifications for medical coder
  • Ability to drive to provider offices in the Daytona and surrounding areas approximately 75% of the time
  • CPC, CRC, CCS-P Coding Certification or CPC-A with coding experience
  • Ability to drive to provider offices in the Glen Allen/Richmond and surrounding areas approximately 75% of the time
  • Ability to drive to provider offices in the Orlando and surrounding areas approximately 75% of the time
  • Minimum of 18 months prior medical coding experience
  • Training and presentation ability
3

Medical Coder Job Description

Job Description Example
Our company is growing rapidly and is hiring for a medical coder. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for medical coder
  • Develop and implement monitoring programs, policies and procedures and reporting tools
  • Learning is a daily part of your role with MedAssets-Precyse – keep your coding knowledge base current with Precyse University, available to all coding colleagues
  • Coding and abstracting patient charts
  • Communicating with physicians and other personnel when needed
  • Detecting and monitoring discrepancies and contact manager for resolution
  • Abstract pertinent information from patient records and assign ICD-9-CM, ICD-10-CM, ICD-10-PCS, CPT, and/or HCPCS codes
  • Review claims, ensure accurate charge capture and review medical necessity for all
  • Follow guidelines for coding and documentation to ensure physicians and hospital compliance
  • Remain current with coding information to ensure accuracy of codes assigned based on documentation
  • Guide, support, and sponsor concurrent clinical coding
Qualifications for medical coder
  • Knowledge of HCPCS, CPT & ICD codes
  • Certified Medical Coder with one of the following active certifications combined with a high degree of competency
  • Prior experience in a medical office environment
  • Knowledge of MRA or HEDIS
  • Organization– Able to work independently
  • CPC, CPC-A or CCS-P Coding Certification
4

Medical Coder Job Description

Job Description Example
Our company is looking for a medical coder. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for medical coder
  • Acts as a liaison between the clinical and coding functions
  • Serve as a resource for coding functions in the Medical Claims Review Unit to ensure proper level of coding and payment of medical claims
  • Evaluate documentation to assign the principal diagnosis, pertinent secondary diagnoses, and procedures for accurate CPT assignment
  • Work with multiple departments to collect all clinical information, medical charts and documents
  • Assign appropriate ICD-9 and CPT-4 codes
  • Handle coding for 20+ different providers
  • Oversee a high volume of claims, invoices, and other coding documents
  • Provide support to providers with any coding issues
  • Support revenue manager
  • Assist manager with maintenance of manuals, newsletters, reference materials
Qualifications for medical coder
  • Minimum of 2 years of experience coding patient records in a hospital HIM departmentt
  • 2+ years experience in coding, and medical records
  • CPC, CPC-H, CCS-P, or CCS certification required within one (1) year of employment
  • Minimum one (1) year experience in ICD-9 and CPT coding for the emergency department preferred
  • Ability to function well in a fast paced, production driven environment
  • Working mandatory overtime at the direction of management
5

Medical Coder Job Description

Job Description Example
Our company is growing rapidly and is looking for a medical coder. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for medical coder
  • Exercises knowledge of medical terminology and physiological systems, Medicare coding rules and regulations
  • Support Precyse’s Compliance Program by demonstrating adherence to all relevant compliance policies and procedures as evidenced by in-service attendance and daily practice
  • Policies and procedures as evidenced by in-service attendance and daily practice
  • Review of inpatient data and reconciliation of billable services including, review of system processing and appropriate escalation and timely communication of errors and omissions and clinical documentation insufficiencies
  • Review and resolution of coding related edits and errors that impact claim submission
  • Provides feedback to Risk and Recovery leadership on performance improvement opportunities as a result of performance gaps
  • Coordinate with program and operations staff, and MMIS IT to update, and maintain ICD logic
  • Reviews provider documentation to determine principal diagnosis, co-morbidities and complications, secondary conditions and surgical procedures
  • Assure appropriate diagnosis and grouper assignment
  • Performing initial charge review to determine appropriate ICD-9, ICD-10, and CPT codes to be used to report services to third party payers
Qualifications for medical coder
  • Completion of accredited coding program (Certified Coding Specialist or Certified Professional Coder)
  • Certified coder through AHIMA, AAPC, PMI or equivalent
  • Minimum of Bachelor’s degree from an accredited university or college experience
  • Knowledge of patient insurances
  • Minimum high school diploma or equivalent, B.S
  • CPC preferred but at least six months previous medical coding experience in a clinic environment is required

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