Under the general supervision of the Revenue Cycle Manager, reviews, analyzes and assures the final diagnoses and procedures as stated by the practicing providers are valid and complete. Accurately codes office and hospital procedures for providers to ensure proper reimbursement. Provides education to the providers to ensure proper completion of Electronic Health Records and proper assignment of ICD-9-CDM and ICD-10-CDM, HCPCS and CPT codes.

The Medical Coder is responsible for the following:

• Audits records to ensure proper submission of services prior to billing on pre-determined selected charges
• Receives hospital information to properly bill provider services for hospital patients
• Supplies correct ICD-9—CM /ICD-10-CM diagnoses codes to all diagnoses provided
• Supplies correct HCPCS code on all procedures and services performed
• Supplies correct CPT code on all procedures and services performed
• Contacts providers to train and update them with correct coding information
• Attends seminars and in-services as required to remain current on coding issues
• Audits medical records to insure proper coding completed and to ensure compliance with federal and state regulatory bodies
• Maintains all mandatory in-services
• Maintains compliance standards in accordance with compliance policies and the Code of Conduct. Reports compliance problems appropriately.
• Determines the final diagnoses and procedures stated by the physician or other health care providers are valid and complete.
• Quantitative analysis – Performs a comprehensive review for the record to assure the presence of all component parts such as: patient and record identifications, signatures and dates where required, and all other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered.
• Qualitative analysis – Evaluates the record for documentation consistency and adequacy. Ensures that the final diagnosis accurately reflects the care and treatment rendered. Reviews the records for compliance with established reimbursement and special screenings criteria.
• Analyzes provider documentation to assure the appropriate Evaluation & Management (E&M) levels are assigned using the correct CPT code
• Performs other duties as assigned, including participation in all safety and compliance programs which may include assignment to an emergency response team.