CODER II - CODING

Hoag; Costa Mesa (CA); Remote; USD 100,000 - 125,000; Full time

Job summary

An established industry player in healthcare is seeking a detail-oriented coding professional to join their dynamic team. This role involves reviewing clinical documentation and applying coding standards to ensure accurate billing and compliance. The ideal candidate will possess a strong understanding of medical terminology and coding guidelines, while also demonstrating exceptional problem-solving skills and attention to detail. With a focus on quality and productivity, this position offers the opportunity to work with a supportive team dedicated to superior patient care. If you are passionate about healthcare and coding, this is the perfect opportunity to make a significant impact.

Qualifications

• Must have coding experience and knowledge of ICD-10-CM and CPT-4.
• Ability to meet productivity and quality standards in coding.

Responsibilities

• Review clinical documentation and assign appropriate codes.
• Ensure timely submission of claims and compliance with billing criteria.

Skills

ICD-10-CM coding

CPT-4 coding

Medical terminology

Anatomy and physiology knowledge

MS Excel

MS Word

MS Outlook

Problem-solving skills

Attention to detail

Strong communication skills

Education

High school diploma or equivalent

Certified coding program

Professional coding experience

Tools

Electronic Health Record (EHR)

Coding Clinic

CPT Assistant

Medical dictionaries and texts

Job description

Salary Range: $35.9500 - $55.2500 /hour. Actual compensation may vary based on geographic location, work experience, skill level, and education.

Reviews clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10-CM, ICD-10-PCS, and/or CPT-4 codes for professional billing, internal and external reporting, research, and regulatory compliance activities. Resolve error reports associated with the professional billing processes, identify and report error patterns and when necessary assist in the design and implementation of workflow changes to reduce billing errors. Must meet ongoing productivity and quality metrics as established within the department for each level.

Essential Functions

• Extract data from one EMR system, interpret and input into Medical Billing system for multiple specialties
• Oversee multiple specialty practices coding work-flow to ensure uniform processes and procedures
• Utilize technical coding principles and reimbursement expertise to assign appropriate ICD-10-CM and CPT-4 procedure codes.
• Assign codes for diagnoses, treatment, and procedures according to the appropriate classification system for Outpatient Procedures and limited Inpatient Procedures, including modifier assignment.
• Review clinical notes to confirm compliance with service billing criteria
• Ensure that claims are submitted efficiently to ensure they are filed within the timely-filing limits of each payer
• Support the in-house billing team as requested to facilitate accurate claims
• Review professional and outpatient medical record documentation and properly identify and assign ICD-10 CM, and/or CPT-4 codes for all reportable diagnoses and procedures:
• Determine the correct principal diagnosis, co-morbidities, complications, secondary conditions, and surgical procedures.
• Queries physicians per established policy and procedure when documentation is not clear or conflicting.
• Possesses a good understanding of Medicare and Medicare specific billing requirements.
• Meet and/or exceed the established quality standard of 95% accuracy rate or better while meeting and/or exceeding established production standards.
• Keeps abreast of coding guidelines by self-study, assigned education, coding meeting attendance, or related in-services. Participates in internal and external quality review meetings.

Education, Training, and Experience

Level I

• Required: High school diploma or equivalent. Two years of professional coding experience or graduation from a CAHIM accredited HIT program and is CCS eligible or RHIT eligible.
• Preferred: Successful completion of a certified coding program. Credentials to include one or a combination of the following: CCA, CCS, CCS-P, RHIT, and/or RHIA. CPC and/or CPC-H will be considered with relevant outpatient coding experience.

Level II

• Required: Two years of professional coding experience including, outpatient procedures and same-day surgery. Successful completion of a certified coding program. Credentials to include one or a combination of the following: CCA, CCS, CCS-P, RHIT, and/or RHIA. CPC and/or CPC-H may be considered with relevant outpatient coding experience.

Level III

• Required: Five years or greater of professional coding experience. Credentials to include one or a combination of the following: RHIA, RHIT, and/or CCS.
• Preferred: Two years of progressive OP diagnostic coding experience.

Skills or Other Qualifications

Required:

• Ability to code and maintain corporate/department-specific quality standards and meet productivity standards as documented by the department and organization.
• Knowledge of medical terminology, anatomy and physiology, disease process, and minor surgical procedures.
• Knowledge of accepted medical abbreviations and their meanings.
• Knowledge in the use of specialized references such as the ICD-10-CM and CPT-4 books, medical dictionaries and texts, and medical journals.
• Must have extensive knowledge of Coding Clinic, CPT Assistant, and all official coding guidelines.
• Advanced knowledge of professional information systems, encoders, and other technology to facilitate a successful virtual work environment while maintaining maximum communication and adhering to HIPAA security standards.
• Advanced knowledge of MS Excel, Word, and Outlook functions.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to all official coding guidelines.
• Technical skills required to learn and navigate a variety of software systems, troubleshoot computer problems, install periodic updates to software programs, and work efficiently in a virtual environment.
• Strong written and verbal communication skills.
• Ability to think/work independently yet interact positively with a remote team.
• Advanced problem-solving skills.
• Familiarity with current healthcare-based technology, coding, and Electronic Health Record (EHR).
• Attention to detail is crucial to this position.

Preferred:

• Knowledgeable in Revenue Cycle department functions relating to Ambulatory Payment Classification (APC) grouping, denials, and edits.

License and Certifications

• Required: See Above by Level
• Preferred: See Above by Level

This position is eligible for remote in California.

About the company

The Hoag Health Network consists of hospitals, urgent care & health care centers in Orange County. They are well known for superior patient care & convenient locations!