Coder I

Eisenhower Health; Oregon; Hybrid; USD 33,000 - 50,000; Full time

Job summary

Eisenhower Health is seeking a skilled Coding Specialist to review E/M and simple visit charges in assigned queues, validating service levels and modifiers for accurate claims. You will also enter manual charges and resolve simple CMS/NCCI edits, contributing to clean claim submission.

Required education includes a high school diploma with coding certification progress or certification (CPC-A/CPC/CCS/RHIT).

Qualifications

• High school diploma or GED required; coding certification pursued or completed preferred.
• Preferred CPC-A/CPC/CCS or RHIT certification within 18 months of hire.
• 1 year billing/charge capture coding experience required.
• Familiarity with ICD-10-CM and CPT/HCPCS coding conventions.

Responsibilities

• Demonstrates compliance with Code of Conduct and compliance policies.
• Maintains quality of work based on current standards.
• Reviews documentation and sequences diagnoses and procedures using coding guidelines.
• Completes claim information and validates for split or non-split payers.
• Communicates with coding staff and management to obtain documentation.
• Completes assigned work queue within productivity standards.
• Obtains and maintains a 95% accuracy rate.
• Maintains knowledge of anatomy, physiology and terminology; pursues ongoing education.
• Performs other duties as assigned.

Skills

Microsoft Office Suite

Coding software familiarity

Denial and appeals process

CMS guidelines knowledge

ICD-10-CM & CPT/HCPCS coding knowledge

Medical terminology & anatomy

Written and verbal communication

Education

High school diploma or GED

CPC-A/CPC/CCS/RHIT coding certification

Enrolled in coding certification program

Tools

Coding software tools

Diagnostic coding software

Job description

Default Work Shift:Day (United States of America)

Hours:40

Salary range:$23.97 - $36.42

Schedule:Full Time

Shift Hours:8 Hour employee

Department:Clinic Billing Services

Job Objective:Reviews E&M and simple visit charges submitted by providers in assigned work queue(s) to validate level of service, place of service, new verses established, and modifier review to ensure valid creation of claim. Reviews and enters manual charges submitted by providers for external services. Reviews and resolves simple NCCI, LCD and MUE edits.

Job Description:Education:Required: High school diploma, GED or higher level degreePreferred: Enrolled in a coding certification program or holding an Apprentice Certificate in coding- CPC or CCS; courses in Medical Terminology, Anatomy and PhysiologyLicensure/Certification:Required: CPC-A, CPC, CSC or RHIT Coding Certification within eighteen (18) months of hireExperience:Required: One (1) year of experience in billing/charge capture coding or related services

Reports To:

Manager-Coding and Charge Capture

Supervises:

N/A

Ages of Patients:

N/A

Blood Borne Pathogens:

Minimal/ No Potential

Skills, Knowledge, Abilities:Ability to use Microsoft Office Suite (Word, Excel, Outlook, PowerPoint) and other relevant software applications, Coding software familiarity, Knowledge of Denial and appeals process, Knowledge of general CMS guidelines and general billing guidelines, Knowledge of ICD-10-CM & CPT/HCPCS coding conventions, Knowledge of medical terminology, anatomy and physiology, Written and verbal communication skills

Essential Responsibilities

• 1. Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations.
• 2. Maintains quality of work based on current published standards.
• 3. Reviews documentation and sequences diagnoses and procedures using current coding guidelines for E&M and simple visit encounters.
• 4. Completes claim information and validates for split or non-split payers.
• 5. Communicates with Coder IIs, department management and clinic staff to obtain needed documentation to ensure correct billing.
• 6. Completes assigned work queue assignments within departmental productivity standards.
• 7. Obtains and maintains a 95% accuracy rate.
• 8. Maintains a thorough understanding of anatomy and physiology, medical terminology, disease processes through participation in continuing education programs to effectively apply ICD-10-CM and CPT-4 coding guidelines to inpatient and outpatient simple visit encounters.
• 9. Performs other duties as assigned.