Job Description

Position Overview 

The Inpatient-Outpatient Coder is responsible for conducting coding audits and education for providers with greatest opportunity for improvement. This individual will ensure medical diagnosis and procedure codes submitted on provider claims are accurate. In addition, this person will review medical records for: physician documentation, clinical evidence that supports the diagnoses, medical necessity of procedures, appropriate setting of care and accurate use of CMS coding guidelines.

Scope of Role & Responsibilities

• Identifies trends and inconsistencies in provider documentation and coding practices.
• Audits and reviews medical records to determine if the medical record is complete, accurate, and in support of individual patient risk adjustment score accuracy.
• Develops curriculum to improve provider coding practices.
• Educates providers and their practice staff in coding guidelines.
• Works in collaboration with other departments, develop plans and materials that support education and system changes to ensure proper coding is a standard practice for all providers.
• Participates in the review and analysis of summary data. Assist with data collection and report generation.
• Maintains the confidentiality and security of sensitive information and files.

Required Education, Training & Professional Experience

• Associate degree required. 
• 2-5 years of health care experience in a physician group practice or other ambulatory care setting preferred.
• 1+ years of medical coding experience with demonstrated sustained coding quality.
• In-depth knowledge of coding/classification systems appropriate for inpatient, outpatient, APR-DRG/MS-DRG and APC/APG prospective payment systems
• Demonstrates advanced knowledge of CPT/HCPS/Revenue Code procedure coding, ICD-9/ICD-10 coding principles and practices.
• Ability to research authoritative citations related to coding, compliance, and additional reporting requirements.
• Demonstrates overall knowledge of claims processing for various insurances both private and government

Licensure and/or Certification Required

• Certification as a professional coder (CPC); or 
• Certification as an inpatient coder (CIC)

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Written/Oral Communication
• Excellent verbal and written communication skills
• Excellent computer skills. Able to learn, use and toggle between multiple systems.
• Analytical skills and ability to create reports, charts, and graphs (e.g. Microsoft Excel)
• Ability to work independently or in a team setting, while handling multiple projects and adjusting to changes quickly while meeting all deadlines

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