Coder III - Risk Management

Advocate Health; Milwaukee (WI); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare organization seeks a Coder III for risk management tasks involving accurate medical coding and ensuring compliance with regulations. The ideal candidate will have advanced knowledge of coding guidelines, substantial experience in professional coding, and certifications from relevant coding bodies. This full-time position offers a chance to excel in a mid-senior role while contributing to vital healthcare processes in a rewarding environment.

Qualifications

• Typically requires 3 years of experience in professional coding.
• Coding Certification from AAPC or AHIMA is necessary.

Responsibilities

• Reviews medical documentation to assign diagnosis and procedure codes.
• Conducts research on coding guidelines and compliance.
• Processes Coding Claim Denials and Rejections.

Skills

Advanced knowledge of ICD, CPT and HCPCS coding guidelines

Advanced knowledge of medical terminology, anatomy and physiology

Advanced communication (oral and written) and interpersonal skills

Advanced analytical skills, with high attention to detail

Education

Advanced training beyond High School in Medical Coding or related field

Tools

Electronic coding systems or applications

Job description

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• Reviews medical documentation at a proficient level from clinicians, qualified health professionals and hospitals in order to assign diagnosis and procedure codes utilizing ICD-10 CM/PCS, CPT, and HCPCS. Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations an EMR and/or Computer Assisted Coding software.
• Adheres to the organization and departmental guidelines, policies and protocols.
• Reviews all clinician documentation to support assigned codes in the health information record so that all significant diagnoses and procedures may be captured for reimbursement and data purposes.
• Conduct independent research to promote knowledge of coding guidelines, regulatory policies and trends.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines. Practices ethical judgment in assigning and sequencing codes for proper insurance reimbursement.
• Maintains the confidentiality of patient records. Reports any perceived non-compliant practices to the coding leader or compliance officer.
• Meets then exceeds departmental quality and productivity standards.
• Recommend modifications to current policies and procedures as needed to coincide with government regulations.
• Responsible for processing Coding Claim Denials and Coding Claim Rejections, when applicable
  
  

Major Responsibilities

• Reviews medical documentation at a proficient level from clinicians, qualified health professionals and hospitals in order to assign diagnosis and procedure codes utilizing ICD-10 CM/PCS, CPT, and HCPCS. Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations an EMR and/or Computer Assisted Coding software.
• Adheres to the organization and departmental guidelines, policies and protocols.
• Reviews all clinician documentation to support assigned codes in the health information record so that all significant diagnoses and procedures may be captured for reimbursement and data purposes.
• Conduct independent research to promote knowledge of coding guidelines, regulatory policies and trends.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines. Practices ethical judgment in assigning and sequencing codes for proper insurance reimbursement.
• Maintains the confidentiality of patient records. Reports any perceived non-compliant practices to the coding leader or compliance officer.
• Meets then exceeds departmental quality and productivity standards.
• Recommend modifications to current policies and procedures as needed to coincide with government regulations.
• Responsible for processing Coding Claim Denials and Coding Claim Rejections, when applicable
  
  

Licensure, Registration, And/or Certification Required

• Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC), or American Health Information Management Association (AHIMA)
  
  

Education Required

• Advanced training beyond High School in Medical Coding or related field (or equivalent knowledge)
  
  

Experience Required

• Typically requires 3 years of experience in professional coding that includes experiences in either hospital or professional revenue cycle processes and health information workflows.
  
  

Knowledge, Skills & Abilities Required

• Advanced knowledge of ICD, CPT and HCPCS coding guidelines. Advanced knowledge of medical terminology, anatomy and physiology.
• Intermediate computer skills including the use of Microsoft office products, electronic mail, including exposure or experience with electronic coding systems or applications.
• Advanced communication (oral and written) and interpersonal skills.
• Advanced organization, prioritization, and reading comprehension skills.
• Advanced analytical skills, with a high attention to detail.
• Ability to work independently and exercise independent judgment and decision making.
• Ability to meet deadlines while working in a fast-paced environment.
• Ability to take initiative and work collaboratively with others.
  
  

Physical Requirements And Working Conditions

• Exposed to a normal office environment.
• Must be able to sit for extended periods of time.
• Must be able to continuously concentrate.
• Position may be required to travel to other sites; therefore, may be exposed to road and weather hazards.
• Operates all equipment necessary to perform the job.
  
  

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

#REMOTE

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Engineering and Information Technology

• Industries

  Hospitals and Health Care

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