Medical Group Coder II

Mohawk Valley Health System; City of Utica (NY); On-site; USD 32,000 - 50,000; Full time

Job summary

Mohawk Valley Health System is seeking a Medical Group Coder II to improve documentation, data quality and revenue cycle operations. You will review medical records to accurately assign HCPCS, CPT and ICD-10-CM codes for hospital-based surgical specialty providers in office, outpatient, and inpatient settings.

The role requires at least two years of surgical-based coding experience or a specialty credential, with proficiency in EMR and coding resources, and knowledge of CMS guidelines.

Qualifications

• Minimum of two years surgical-based coding experience or specialty-based professional credential.
• Knowledge of EMR, electronic coding resources, Microsoft Office and email systems.
• Knowledge of CMS guidelines and insurance company rules is preferred.

Responsibilities

• Assign HCPCS, CPT, CPTII, CPTIII and ICD-10-CM codes for professional services across settings.
• Assign modifiers and review medical necessity, CMS edits and internal/external coding edits.
• Query providers for incomplete or unclear documentation and ensure timely resolution.
• Educate providers and clinical staff on documentation and workflow opportunities.
• Assist departments with diagnostic and procedural coding and support business office with denials.

Skills

Surgical coding experience

Querying providers

Tools

Epic

3M ICD-10-CM/CPT

Vitalware

Microsoft Office

Email systems

Job description

Medical Group Coder II

Under the direct supervision of the Assistant Director of Revenue Cycle Management or Coding Supervisor, the Medical Group Coder will improve documentation, data quality and revenue cycle operations. The coder reviews and analyzes medical records to accurately select all forms of HCPCS service codes (HCPCS, CPT, CPTII, CPTIII) and ICD-10-CM codes for professional services of hospital-based surgical specialty providers. This includes services in the office or other outpatient settings and inpatient settings.

Core Job Responsibilities

• Assign the applicable HCPCS (HCPCS, CPT, CPTII, CPTIII) service codes based on review and analysis of medical records, following CMS, CPT, insurance company, hospital based and office based guidelines.
• Assign applicable modifiers, review medical necessity, CCI and other internal and external coding edits.
• Assign applicable ICD-10-CM diagnosis codes based on knowledge of ICD-10-CM, insurance company, hospital based and office based guidelines.
• Submit queries to providers, clinical staff and managers regarding incomplete, unclear, or inconsistent documentation. Re-submit queries as necessary to ensure timely resolution.
• Provide education to providers and clinical staff regarding documentation and work flow opportunities.
• Assist departments with diagnostic and procedural coding.
• Assist Business Office with insurance denials.
• Perform other duties as required.

Education/Experience Requirements

• REQUIRED: Minimum of two years surgical based coding experience or specialty based professional credential Knowledge of EMR, electronic coding resources, Microsoft Office and email systems
• PREFERRED: Completion of specialty based coding coursework or equivalent Knowledge of Epic, 3M ICD-10-CM and CPT software, Vitalware, Microsoft Office, Email systems Knowledge of CMS Teaching Physician Guidelines for Residents and Medical Students 2 years of hospital based, specialty based professional coding experience, or equivalent

Licensure/Certification Requirements

• REQUIRED: CPC, CCS-P, or related AHIMA or AAPC professional specialty certification
• PREFERRED: CPC, CCS-P, or specialty based professional credential

Disclaimer Qualified applicants will receive consideration for employment without regard to their age, race, religion, national origin, ethnicity, gender (including pregnancy, childbirth, et al), sexual orientation, gender identity or expression, protected veteran status, or disability. Successful candidates might be required to undergo a background verification with an external vendor.

Job Details Req Id 99005 Department MEDICAL GRP ADMIN Shift Days Shift Hours Worked 8.00 FTE 1 Work Schedule HRLY NON-UNION-8 HR Employee Status A1 - Full-Time Union Non-Union Pay Range $23.00 - $36.00 Per Hour