Required Min : 3 years of Emergency Department supporting ED will only be considered .
Medical Coder (Coding Representative) – Remote Eligible Responsible for assigning accurate and complete ICD-10-CM diagnosis codes, CPT/HCPCS procedure codes, and performing E&M validation for facility and physician Emergency Department services, utilizing the ACEP E&M tool and applicable coding guidelines.
Position Responsibilities
• Review medical record documentation to assign accurate and complete ICD-10-CM diagnosis codes and CPT/HCPCS procedure codes, as well as perform E&M validation for facility and physician Emergency Department services using the ACEP E&M tool, in accordance with ICD-10 Official Coding Guidelines, regulatory requirements, and coding compliance policies.
• Adopt and incorporate initiatives that improve compliance and reduce risks to the institution.
Key Areas of ResponsibilityPatient Revenue Management
• Review medical record documentation to assign correct diagnoses and CPT/HCPCS procedure codes.
• Perform facility and physician Emergency Department E&M validation utilizing the ACEP E&M tool to ensure appropriate level assignment and compliance with documentation requirements.
• Determine if billed data complies with documentation, payer requirements, and regulatory guidelines.
• Adopt and incorporate initiatives that improve compliance and reduce risks to the institution.
Operations and Performance Standards
• Monitor compliance standards and policies to ensure the organization receives full and accurate reimbursement for services in accordance with payer rules and regulations.
• Contribute to the development of tools and processes that address underlying causes of incorrect payment.
• Review HB (Hospital Billing) and PB (Physician Billing) charge review work queues for accounts with edits.
• Identify potential process improvements, including denial prevention and denial management activities.
• Maintain proficiency in Emergency Department coding guidelines, facility E&M methodologies, and ACEP E&M criteria.
Communication/Training
• Communicate with co-workers, supervisors, and departments to resolve coding and documentation issues.
• May assist with or provide training to providers regarding documentation requirements and coding guidelines.
• Communicate with healthcare providers to resolve documentation deficiencies, including incomplete or unsigned documentation, or when additional information is needed to ensure complete and accurate code assignment.
• Participate in internal coding education, compliance initiatives, and developmental training.
Required Certification
Requires Health Information Management certification such as RHIA or RHIT, or coding certification (CCS, CCA, CPC, etc.) through a nationally recognized credentialing body such as AHIMA or AAPC.
Required Qualifications
• 3 years of experience with hospital outpatient ICD-10-CM and CPT medical coding.
• 3 years of experience performing Emergency Department facility and physician E&M validation, including use of the ACEP E&M tool.
• Strong experience with injection and infusion coding, including assignment and validation of CPT/HCPCS codes for hydration, therapeutic, prophylactic, diagnostic injections and infusions, chemotherapy, and biologic administration services in accordance with CPT and CMS guidelines.
• Knowledge and understanding of CMS regulations, payer requirements, and industry standards.
• Knowledge and experience utilizing Epic.
• Knowledge and experience utilizing 3M (or equivalent) encoder/analyzer software.
• Knowledge of hospital outpatient ICD-10-CM and CPT medical coding.
• Knowledge of Emergency Department facility and physician E&M guidelines and validation methodologies.
• Knowledge of ACEP Emergency Department facility E&M leveling criteria and application.
• Knowledge of medical terminology.
• Knowledge of anatomy and physiology.
Work Location: Remote