PACE Medical Coder (Hybrid)

SAN-Ysidro-Health; San Diego (CA); Hybrid; USD 65,000 - 90,000; Full time

Job summary

San Ysidro Health is seeking a PACE Medical Coder to review clinical documentation and verify ICD-10-CM, CPT and HCPCS codes in a hybrid role. Remote work predominates, with quarterly on-site meetings to align on coding standards and reimbursement processes.

Candidates must reside in California or relocate prior to employment. The role requires CPC or CCS certification, at least one year of medical coding experience, and strong knowledge of ICD-10-CM, CPT, and HCPCS, along with proficient

Qualifications

• One year of medical coding experience required with a CPC or CCS.
• CPC or CCS certification required.
• Strong written and verbal communication skills.
• Extensive knowledge of ICD-10-CM, CPT and HCPCS coding; proficient in EHR systems.

Responsibilities

• Review chart progress notes and patient documentation to assign ICD-10-CM, CPT and HCPCS codes.
• Verify diagnostic and procedural codes from EHRs using ICD-10-CM, CPT and HCPCS classifications.
• Communicate with providers to ensure accurate documentation for proper coding and reimbursement.
• Identify chargeable items within progress notes to assign correct CPT/HCPCS codes.
• Apply sequencing guidelines for diagnosis and principal diagnosis/procedure per ICD-10 guidelines.
• Track encounter reports to ensure proper coding across all patients seen.

Skills

Medical terminology

Communication skills

Team collaboration

Education

High School Diploma or GED

Tools

Excel

Word

Job description

Position Summary:

The PACE Medical Coder will review clinical documentation and diagnostic results as necessary to verify the appropriate assignment of the ICD-10 CM, CPT and HCPCS codes as per Official Guidelines for Coding and Reporting.

This position is intended to be a hybrid role, where the incumbent will be expected to primarily work remotely. There is a minimum expectation to attend On-Site Quarterly Meetings; additional on-site presence may be required based on business need.

To be considered for this role, candidates must either currently live in California or demonstrate a willingness to relocate prior to employment.

Essential Functions of the Job:

• Review the Chart Progress Notes, patient documentation for diagnoses, procedures, and services performed by physicians and other qualified healthcare providers.
• Verifies all diagnostic procedural codes from the electronic health record using ICD-10 CPT and HCPCS coding classifications.
• Communicates effectively with providers concerning documentation to assure proper coding and reimbursement.
• Identify all chargeable items within each progress note to ensure proper CPT/HCPCS codes for each of the items.
• Apply sequencing guidelines for the diagnosis codes and selection of the principal diagnosis and procedure according to ICD-10 guidelines
• Tracks open/close encounter reports to assure that all patients seen in the clinic are properly coded.
• Organizes & prioritizes all work to ensure that records are coded in time frames that will be in line with department policies.
• Maintains knowledge of Anatomy & Physiology to interpret general medical classifications for coding including the most complicated encounters/cases.
• Acts as an expert resource person to other coders & personnel in other departments regarding coding questions & issues.
• Participates in ongoing education, including in-service training and other activities to maintain and improve competence.
• Adheres to SYHC's Core Competencies and professional Code of Conduct Behavior Standards in their day-to-day work by consistently demonstrating the Core Values of Respect, Excellence, Integrity and Empowerment.
• Performs any other related job duties as assigned and/or requested.

Additional Duties and Responsibilities:

• Adheres to all applicable SYHC's Policies, Procedures and processes.
• Demonstrates skills in collaboration with team and problem-solving.
• Excellent written and oral communication skills.
• Enhances professional growth and development through participation in educational programs, current literature, in-service meetings and workshops.
• Attends meetings as required and participates on committees as directed.
• Demonstrates courtesy and treats every patient and employee with dignity in every interaction.
• Assists in the maintenance and/or revision of established Departmental Policies and Procedures.
• Maintains confidentiality of all patient electronic medical records.
• Maintains a clean, safe, and organized work area at all times.
• Performs all other related duties as assigned or requested.

Job Requirements

Experience Required:

• One (1) year of medical coding experience required with a CPC or CCS.

Education Required:

• High School Diploma or GED Equivalent.

Certifications Required:

• Current Procedural Coder (CPC) Certification from the American Academy of Professional Coders (AAPC) or AHIMA American Health Information Management Association certification required.

Verbal and Written Skills Required to Perform the Job:

• Good oral and written communication skills.
• Good customer service skills.

Technical Knowledge and Skills Required to Perform the Job:

• Extensive knowledge of medical terminology, human anatomy and physiology.
• Knowledge of diagnostic tests, procedures, pathology terms and drug reference books. Knowledge of ICD-10-CM and HCPCS/CPT, HCC coding & abstracting procedures.
• Proficient in typing skills and experience with using computers and software systems.

Equipment Used:

• General office equipment to include PC and Software (Excel, Word, Office), phone, fax, etc.

Working Conditions and Physical Requirements:

• This position is intended to be a hybrid role, where the incumbent will be expected to primarily work remotely. There is a minimum expectation to attend On-Site Quarterly Meetings; additional on-site presence may be required based on business need.
• Prolonged, extensive, and considerable standing/walking; always reaching, stooping ending, kneeling, crouching; manual dexterity and mobility.
• Able to work in a noisy setting.
• Ability to handle multiple activities simultaneously.
• Good organizational skills.
• Willing to work with others as a team member.
• Detailed-oriented.
• May be required to work evenings and/or weekends.

Universal Requirements:

Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs. Compliance with all mandated vaccinations and all boosters is a term and condition of employment.