Job Description

The Medical Coder is primarily responsible for performing chart reviews and coding audits; reviewing appropriate ICD-10 diagnoses codes, and CPT and HCPCS procedure codes assigned for evaluation and management of the patient. Additional responsibilities include supporting pre-or post-payment coding audit for benchmark and/or reimbursement recovery, and other coding-related activities such as pre-appointment chart audits for HCC or risk adjustment, appeals of denied claims, providing information or education to providers for specificity of documentation to align with the coding guidelines to comply with federal, state, and regulatory requirements.

ESSENTIAL JOB FUNCTIONS:

• Performs pre-appointment HCC or risk adjustment chart reviews, coding audits, or other coding-related projects.
• Acts as internal resource for all coding inquiries from providers, Billing, Laboratory, Radiology, and other departments. 
• Provides real time coding consultation and review and evaluation of documentation to improve coding practices.
• Provides training to providers and Billing staff on use of ICD-10 codes.
• Queries provider documentation as appropriate.
• Provides Billing staff with coding and documentation information necessary to process a claim for reimbursement.
• Maintains knowledge of current coding guidelines and standards, annual updates, changes, additions, and deletions to ensure coding and billing compliance.
• Communicates code changes to appropriate departments.
• Reviews and updates coding policies and procedures as needed.
• Assigns appropriate ICD-10 and CPT codes to patient encounters as needed.
• Assists Revenue Cycle manager and billing staff on technical projects.
• Acts as resource for providers for medical documentation inquiries.
• Performs other job duties as required by manager/supervisor.

QUALIFICATIONS:

• Completion of an AA or AS degree.
• Possession of AAPC or AHIMA credential such as CPC, CPC-P, CPMA, RHIT, RHIA, CCS, or CCS-P.
• Minimum of two years’ experience working in the healthcare industry in the areas of HCC or risk adjustment, health information, chart audit, medical coding, or billing.
• Prior coding experience highly preferred.
• Knowledge of medical terminology, anatomy, pathophysiology, pharmacology, CPT, ICD-10, clinical documentation, or medical billing processes.
• Excellent verbal and written communication skills.
• Experience with Microsoft Office (Word, Excel, PowerPoint) and Outlook.
• Detail-oriented and problem-solving skills.
• Ability to work independently with minimal supervision.
• Experience in an FQHC or community health center setting preferred.

LANGUAGE:

• Must be able to fluently speak, read, and write English.
• Fluent in other languages are an asset.  

STATUS:

This is an FLSA Non-exempt position.
This is not an OSHA high-risk position.

NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).

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