Medical Coder

Iannarino Fullen Group; Cranston (RI); Sur place; USD 41 000 - 59 000; Plein temps

Résumé du poste

Iannarino Fullen Group in Cranston, RI is seeking a MedicalCoder/CodingSpecialist to review inpatient and outpatient records, assign ICD-10-CM and CPT-4 codes, and ensure accurate documentation for reimbursement. Strong knowledge of terminology and coding regulations is required.

The role emphasizes accuracy, confidentiality, HIPAA compliance, collaboration with physicians and billing staff, and supporting timely billing.

Qualifications

• College degree in medical records science or health information management
• AHIMA CCS certification or CPC certification may be required
• Equivalent mix of education and experience acceptable

Responsabilités

• Review inpatient and outpatient records to extract accurate information
• Assign ICD-10-CM and CPT-4 codes per guidelines
• Support billing and documentation quality and compliance
• Collaborate with physicians and billing staff to resolve discrepancies
• Maintain confidentiality and HIPAA compliance

Connaissances

Medical terminology

Anatomy

Physiology

Pathology

Pharmacology

Diagnostic testing

Medical procedures

ICD-10-CM knowledge

CPT-4 knowledge

HIPAA compliance

Communication skills

Analytical skills

Formation

Health Information Management degree

CCS certification

CPC certification

Equivalent education/experience

Outils

Coding software

EMR/EHR systems

Healthcare information systems

Description du poste

Job Description

MedicalCoder/CodingSpecialist

JobType:8:30AM-4:00PM(Mon-Fri)

Department:MedicalRecords/HealthInformationManagement

WorkLocation:Cranston,RI

Pay:$36.17

JobSummary

Weareseekingadetail-orientedandknowledgeableMedicalCodertoreview,evaluate,andanalyzeinpatientandoutpatientmedicalrecordstoensureaccuratediagnosticandproceduralcoding,completemedicalrecordabstraction,andappropriatehealthcarereimbursement.Theidealcandidatewillhaveastrongunderstandingofmedicalterminology,anatomy,physiology,pathology,ICD-10-CM,andCPT-4codingsystems,alongwithexperienceinterpretinghealthcaredocumentationandapplyingcodingregulations.

TheMedicalCoderwillcollaboratewithphysicians,medicalrecordspersonnel,billingstaff,andotherhealthcareprofessionalstoresolvedocumentationdiscrepancies,maintainaccuratepatientrecords,andsupporttimelyandcompliantbillingandreimbursementprocesses.Thisrolerequiresahighlevelofaccuracy,confidentiality,analyticalability,andknowledgeofMedicare,Medicaid,andotherthird-partypayerrequirements.

KeyResponsibilities

• Reviewandevaluateinpatientandoutpatientmedicalrecordstoextractaccuratediagnostic,procedural,anddemographicinformation.
• AssignappropriatediagnosisandprocedurecodesusingapplicableICD-10-CMandCPTcodingguidelinesandregulations.
• Applycurrentcodingstandardsandreimbursementrequirementstosupportaccurateandappropriatefinancialreimbursement.
• Ensurecorrectcodeselection,sequencing,anddocumentationofdiagnosesandprocedures.
• Identifyincomplete,unclear,inconsistent,orquestionablemedicaldocumentationandrefercasestotheattendingphysician,MedicalRecordsDirector,orMedicalDirectorforclarificationandresolution.
• Providecodingguidanceandtechnicalassistancetophysicians,medicalrecordspersonnel,andbillingstaff.
• Collaboratewiththebillingdepartmenttomaintainaccuratedata,supportinternalcontrols,andminimizecodingandbillingerrors.
• Verifyinformationdocumentedonpatientabstractforms,includingapplicablePSIabstractforms,andreviewsupportinginformationforaccuracyandcompleteness.
• Usecomputersystemsandhealthcaredatabasestoverifypatientcoverage,insuranceeligibility,andapplicablereimbursementrequirements.
• Ensurecodedandabstractedmedicalrecordsarecompletedandforwardedtothebillingdepartmentinatimelymanner.
• Maintainaweeklystatuslogofadmissions,transfers,anddischargestotrackmedicalrecordsandensurerecordsareaccountedforandcompleted.
• Abstractandenteraccuratemedicalinformationintofinancial,statistical,andbillingdatabases.
• Maintainstrictconfidentialityofpatienthealthinformationandcomplywithapplicableprivacypoliciesandregulations,includingHIPAA.
• Assistsupervisorsandmedicalstaffwithadditionalmedicalrecords,coding,documentation,andreimbursement-relateddutiesasassigned.

RequiredKnowledge,Skills,andAbilities

• Extensiveknowledgeofmedicalterminology,anatomy,physiology,pathology,pharmacology,diagnostictesting,andmedicalprocedures.
• StrongworkingknowledgeofICD-10-CMandCPT-4codingclassificationsystemsandapplicablecodingguidelines.
• UnderstandingofMedicare,Medicaid,commercialinsurance,andotherthird-partypayerrequirements.
• Knowledgeofhealthcarebilling,reimbursementpolicies,andmedicalrecorddocumentationstandards.
• Abilitytoaccuratelyinterpretclinicaldocumentationandassignappropriatediagnosisandprocedurecodes.
• Abilitytoidentifydocumentationdeficienciesandcommunicateeffectivelywithphysiciansandotherhealthcareprofessionalstoobtainclarification.
• Stronganalytical,organizational,problem-solving,anddataabstractionskills.
• Proficiencyinelectronicmedicalrecords,codingsoftware,andhealthcareinformationsystems.
• Excellentwrittenandverbalcommunicationskillsandtheabilitytocollaborateacrossclinical,medicalrecords,andbillingdepartments.
• Demonstratedcommitmenttoaccuracy,confidentiality,compliance,andtimelycompletionofassignedwork.

EducationandExperience

Candidatesshouldmeetoneofthefollowingeducationalorprofessionalqualificationpathways:

• Graduationfromanaccreditedcollegewithaspecializationinmedicalrecordsscienceorhealthinformationmanagement.
• Graduationfromanapprovednursingschool,togetherwithCertifiedCodingSpecialist(CCS)certificationthroughtheAmericanHealthInformationManagementAssociation(AHIMA).
• CertifiedProfessionalCoder(CPC)certificationthroughtheAmericanAcademyofProfessionalCoders(AAPC),asapplicabletotheemployer'srequirements.
• Anequivalentcombinationofeducation,professionalcertification,andrelevantexperiencethatdemonstratestherequiredknowledgeandcompetencies.

Experience

• PreviousemploymentasaMedicalCoder,CodingAbstractor,CodingSpecialist,orinacomparablemedicalrecordscodingposition.
• ExperiencereviewinginpatientandoutpatientmedicalrecordsandapplyingCPTcodingstandardsinahospitalreimbursementenvironment.
• Demonstratedabilitytoabstractmedicalinformation,supportbillingprocesses,andresolvecodingordocumentationdiscrepancies.

PreferredQualifications

• Experienceinanacute-carehospitalorotherapprovedinpatient/outpatienthealthcarefacility.
• Experiencewithmedicalrecordabstraction,codingaudits,reimbursementreview,andbillingdatavalidation.
• Familiaritywithhealthcarepayerpoliciesandelectronichealthrecordsystems.
• Currentprofessionalcodingcertification,suchasCCSorCPC.