Coder, Certified Professional - FT Days

Three-Crosses-Regional-Hospital; Las Cruces (NM); On-site; USD 54,000 - 76,000; Full time

Job summary

The Certified Coder at Three Crosses Regional Hospital will code ICD-10-CM/ICD-10-PCS and CPT data for administrative and clinical records, ensuring compliance with federal and state regulations and hospital policies. The role requires high ethical standards and confidentiality.

Key duties include pre- and post-payment claim analysis, chart reviews, audit scheduling, documentation of findings, education of providers on coding practices, and collaboration with revenue cycle leadership.

Qualifications

• Must have high school diploma or equivalent.
• Preferred: 3+ years medical coding experience.
• One coding certification from AAPC or AHIMA (CCA, CPC, CPB, CCS, CIC, COC, CCS-P).
• Meet all Employee Health Requirements.
• Experience with CPT, ICD-10-CM, ICD-10-PCS and risk adjustment guidelines.

Responsibilities

• Independently perform analysis of claims pre- and post-payment using CPT, ICD-10, and risk adjustment guidelines.
• Review medical records to validate or invalidate coding and billing issues.
• Develop and maintain an audit schedule in coordination with leadership and providers.
• Document findings to support claim adjustments with records and coding rationale.
• Identify process gaps contributing to incorrect payments.
• Ensure PHI confidentiality and security.
• Apply clinical and coding expertise for accurate documentation and claim submission.
• Collaborate with staff and Revenue Cycle leadership to resolve coding queries.

Skills

Critical thinking

Time management

Problem solving

Verbal communication

Written communication

Organization

EMR experience

Medical chart auditing

Medical terminology

Education

High School Diploma

Job description

The Certified Coder is responsible for the timely and accurate coding of administrative and clinical data through the assignment of ICD-10-CM, ICD-10-PCS, and/or CPT codes. This position ensures compliance with all federal regulations, state licensing requirements, and the policies and procedures of Three Crosses Regional Hospital.

The incumbent will carry-out duties by adhering to the highest standards of ethical and moral conduct, acts in the best interest of Three Crosses Regional Hospital, and fully supports the mission, vision, and values of Three Crosses Regional Hospital.

Primary Responsibilities

• Independently perform analysis of claims on a pre- and post-payment basis utilizing clinical, coding and claims Independently analyze claims on both a pre- and post-payment basis, utilizing clinical, coding, and claims processing knowledge to ensure accuracy in accordance with CPT, ICD-10, and risk adjustment guidelines
• Review medical records to validate or invalidate potential coding and billing issues identified on claims
• Develop and maintain an individual audit schedule in coordination with leadership and providers
• Thoroughly document findings to support claim adjustments, including supporting medical records and coding rationale
• Identify and document process gaps contributing to incorrect payments
• Ensure the security and confidentiality of all protected health information (PHI) accessed during work activities
• Apply clinical and coding expertise to ensure accurate and complete documentation for coding and claim submission
• Report missing charges and reconciling discrepancies prior to claim submission
• Identify opportunities to educate providers, staff, and colleagues on documentation and coding best practices
• Meet established productivity, accuracy, timeliness, and documentation standards
• Collaborate with clinical staff and the Director of Revenue Cycle to resolve coding queries and support claim progression through the revenue cycle
• Adapt to new systems, technologies, and coding updates with flexibility and efficiency
• Attend staff meetings as required
• Other duties as assigned.

Knowledge, Skills and Abilities

• Demonstrate critical thinking, time management and problem-solving skills
• Excellent verbal and written communication (including documentation) skills
• Ability to organize and prioritize tasks
• Experience with electronic medical records system
• Experience with medical record documentation, medical chart auditing/quality experience
• Advanced knowledge of medical terminology, abbreviations, anatomy and physiology, major disease processes, and pharmacology

Education and Experience:

• Required:High School Diploma or equivalent
• Preferred: 3+ years medical coding experience
• Required: Meet all Employee Health Requirement

License/Certification(s)

• Required: One certification from CCA, CPC, CPB, CCS, CIC, COC, CCS-P accredited from AAPC or AHIMA