Medical Coder

Overview

Reporting to the Senior Medical Coder/ Coding Supervisor, the Medical Coder role is responsible for reviewing coding of medical cases, handling claims submission to payers, and all revenue cycle/billing tasks assigned. The role is also responsible in ensuring the accuracy of the coding in patient health records.

Responsibilities

Pro-actively participates in collaboration with the Line Manager tomeet the division’s strategic and operational goals.
Adheres to the division’s policies, procedures and standards while ensuring compliance with applicable regulatory bodies.
Reviews medical records documented by physicians, nurses and other clinical staff and ensures all medical records are in place with no missing documentation.
Validates physicians’ clinical documentation data quality and provides documentation tips/training to concerned staff for improved reporting to senior management.
Provides data to authorized personnel for studies and/or research purposes.
Assists in external medical audits by coordinating with the auditors and providing access to the required medical records.
Performs periodic internal audits to improve and sustain quality levels and compliance.
The incumbent checks and sequences the most accurate ICD10- CM/CPT/HCPCS/DRG/Other codes for diagnoses and procedures for documented information.
Assures the final diagnoses and operative procedures stated by the physician are valid and complete.
Abstracts all necessary information from health records to identify secondary complications and co-morbid conditions.
Evaluates the record for documentation consistency and adequacy.
Ensures that the final diagnosis accurately reflects the care and treatment rendered. Computes and gives the correct DRG coding for all inpatients cases.
Query physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous or
unclear for resubmission purposes.
Ensures coding as per DOH/DHA guidelines and regulations.

Qualifications