Professional Coder

ICONMA; Canada; Remote; CAD 50,000 - 90,000; Full time

Job summary

An established industry player is seeking a detail-oriented medical coder to ensure accurate documentation and coding in healthcare records. In this role, you will review and analyze medical records, ensuring compliance with coding guidelines and regulations. Your expertise will support critical audits and improve overall documentation quality. This position offers a chance to work collaboratively within a team, contributing to meaningful improvements in healthcare documentation. If you are passionate about coding and committed to excellence, this role is an exciting opportunity to make a significant impact.

Qualifications

• Current RHIT, CPC, or CCS certification required.
• Experience in medical coding and health insurance preferred.

Responsibilities

• Review medical records for accuracy and compliance with coding guidelines.
• Support coding improvement tools and assist in educational activities.

Skills

CPT Coding

HCPCS Coding

ICD Coding

Medical Terminology

Communication Skills

Problem-Solving Skills

Education

Registered Health Information Technician (RHIT)

Certified Professional Coder (CPC)

Certified Coding Specialist (CCS)

Bachelor's Degree

Tools

Microsoft Word

Microsoft Excel

Job description

Position Overview

This position is responsible for accurately reviewing, interpreting, auditing, coding, and analyzing medical record documentation to ensure diagnosis accuracy, proper documentation, and Hierarchical Condition Category (HCC) abstraction. The review may include inpatient, outpatient treatment, and/or professional medical services, following ICD-/ICD-CM coding guidelines and risk adjustment model regulations. This role supports Annual Commercial (ACA) and Medicare Advantage Risk Adjustment Data Validation Audits (RADV), as well as the annual Risk Adjustment lifecycle for Medicare, Medicaid, and Commercial lines of business.

Responsibilities

1. Understand and translate CPT, HCPCS, ICD-/ICD- codes for HCC abstraction.
2. Review medical records for completeness, accuracy, and compliance with coding guidelines and regulations.
3. Identify, compile, and code member/patient data using ICD-/ICD- CM and other classification systems.
4. Support the collection and distribution of documentation and coding improvement tools for designated practice units.
5. Assist in educational activities for internal stakeholders as a coding review subject matter expert.
6. Participate actively in program improvement discussions and activities.
7. Maintain department productivity and accuracy standards.

Qualifications

• Current Registered Health Information Technician (RHIT) or Certified Professional Coder (CPC) from the American Academy of Professional Coders, or Certified Coding Specialist (CCS) from AHIMA.
• Number of years of medical coding experience.
• Minimum years of experience in health insurance, quality chart audits, or utilization review.
• Bachelor's degree preferred.

Knowledge

• Proficiency in CPT, HCPCS, ICD-/ICD- codes.
• Knowledge of medical terminology, procedures, abbreviations, and terms.
• Understanding of the healthcare delivery system.

Skills and Abilities

• Proficiency in personal computer use and software such as Word and Excel.
• Effective verbal and written communication skills.
• Ability to work well within a team.
• Professional and ethical business practices, adherence to standards, and commitment to development.
• Sound judgment and problem-solving skills.
• Ability to ask probing questions and gather relevant information.

Disclaimer

This job summary outlines the general nature and level of work performed by colleagues within this classification. It is not exhaustive of all duties, responsibilities, and qualifications required.

The description aims to reflect the general nature of the work performed by incumbents. It is not an exhaustive list of all responsibilities, duties, and skills required.