POSITION SUMMARY:  Responsible for reviewing medical records and translating the information about the patient's visit into codes for insurance carriers to process claims.

MINIMUM QUALIFICATIONS: 

• Evaluates medical record documentation and charge ticket coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflect and support the outpatient visit.  
• Interacts with physicians and other patient care providers in coding admission, principle, and secondary diagnoses and coding principal and secondary procedures to promote appropriate reimbursement.  
• Interacts with the Insurance Department for timely processing of claims.  
• Abstracts diagnoses and procedures from medical records into the Physician Health Information System for timely billing.  
• Evaluates medical records and charge tickets to ensure completeness, accuracy, and compliance with the International Classification of Diseases Manual - Clinical Modification (ICD-10-CM), and the American Medical Association’s Current Procedural Terminology manual (CPT).
• Provides technical guidance and training on medical coding to physicians and staff.
• Performs within the prescribed limits of the hospital's/department's Ethics and Compliance program. Detects, observes and reports compliance variances to the department director or upward through the chain of command, the Compliance Officer, or hospital hotline. 
• Performs related duties as required

Required: 
• High School Diploma or equivalent. 
• Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Certified Outpatient Coder (COC), or other coding certification.
 

Preferred: Experience in coding for physicians and/or provider practice locations and services based on Medical Records documentation.

Some on-location meetings are required - for example, training and IT updates.