Certified Professional Coder
Certified Coding Specialist | San Antonio, TX | Full Time
Medical Records Coding Specialist – San Antonio, TX
Review, interpret, and assign diagnostic and procedural codes based upon medical record documentation according to correct coding principles. Provide skilled and specialized documentation and coding for medical billing, abstracts complex patient-related data from medical records and coding of diagnoses and procedures using ICD-10 and CPT codes. Work coding related charge review and claim edits daily to ensure timely and accurate billing. Research and resolve coding related denials forwarded by insurance follow-up team.
- Maintains a working knowledge of CPT and ICD-10 coding principles, governmental regulations, protocols and third-party requirements regarding billing and documentation.
- Interprets clinical data using working knowledge of anatomy, physiology, disease process and medical terminology
- Selects correct ICD-10-CM (diagnostic) and CPT-4 (procedural) codes based upon interpretation of operative procedure and correct coding principles. Queries when appropriate. Remains up to date on all coding changes and usage.
- Interprets current NCCI edits and applies “bundling” and “unbundling” rules according to payer requirements, if different from CPT-4 coding guidelines.
- Applies correct modifiers to procedure codes, when warranted, according to CPT-4 guidelines and Medicare/Carrier instructions.
- Assures that all codes assigned are supported by documentation in the medical record; if services are not documented appropriately, will seek to obtain proper documentation before submitting codes for billing. Volume of encounters to be coded must demonstrate an acceptable level of production.
- Achieves and maintains a 95% accuracy in coding while adhering to defined production standards.
- Works coding-related charge review and claim edits daily to ensure timely and accurate billing. May also include working denials queue.
- Researches and resolves coding related denials forwarded by insurance follow-up team.
- Provides accurate answers to physician coding questions in a timely manner.
- Maintains a working knowledge of the Epic system.
Education and Experience:
- Minimum high school diploma or equivalent and at least one-year experience in medical record abstraction and coding
- Required certification from one of the following accreditation agencies; American Health Information Management Association (AHIMA), American Association of Professional Coders (AAPC), Practice Management Institute (PMI) or certification as a Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA) or as a Certified Coding Specialist (CCS).
- Knowledge of ICD-10, CPT-4 and HCPCS coding systems, guidelines and rules. Knowledge of medical record filing systems, medical terminology and medical procedures.
- Knowledge of billing regulations, insurance coverage limitations and managed care protocols.
- Possess communication skills to interact with physicians, patients and staff. Ability to write routine correspondence.
- Ability to use appropriate judgment, independent thinking and creativity when resolving issues. Ability to balance multiple priorities and effectively handle challenging situations.
* Knowledge of Word Processing software, database software, spreadsheet and Internet software.
*Epic experience a plus.