Certified Coder
Pinehurst Surgical
Pinehurst, NC US
Posted ago
Pinehurst Surgical

Certified Coder - Patient Financial Services Department

Full Time 40 hours per week

Full benefits and bonus potential!

Revenue Cycle Management Experience Required

Summary:

The Coder is to apply the appropriate diagnostic and procedural codes to individual patient health records for claims processing. The primary function of this position is to perform ICD-10-CM, CPT and HCPCS coding to optimize reimbursement and to support the department mission of submitting claims correctly upon first submission.

Responsibilities

Determine Accurate Codes of Diagnosis:

  • Performs a comprehensive review of the record to assure the presence of all component parts such as patient and record identification, signatures and dates where required.
  • Ensures the final diagnosis accurately reflects the care and treatment rendered.
  • Codes diagnostic and procedural information that determine Medicare, Medicaid and private insurance payments.
  • Evaluates the record for documentation consistency and adequacy.
  • Analyzes provider documentation to assure the appropriate Evaluation and Management (E & M) levels are assigned using the correct CPT code.
  • Make corrections on coding using Code Correct, Claims Manager, Blue-E, and other electronic coding tools.
  • Ensure compliance with established coding guidelines, third party reimbursement policies, and accreditation guidelines.
  • Query physicians when coding is not straight forward or when documentation in the electronic medical record is inadequate, ambiguous or unclear for coding purposes.

Performs a comprehensive review of the record:

  • Assures the presence of all component parts such as patient and record identification, signatures and dates and checks insurance eligibility and authorizations when warranted.
  • Evaluates the record for documentation consistency and adequacy.
  • Ensures the final diagnosis accurately reflects the care and treatment rendered.
  • Analyzes provider documentation to assure the appropriate Evaluation and Management (E & M) levels are assigned using the correct CPT code.
  • Ensures compliance with established coding guidelines, third party reimbursement policies, and accreditation guidelines.

Codes and Corrects:

  • Codes diagnostic and procedural information that determine Medicare, Medicaid and private insurance payments.
  • Make corrections on coding using Code Correct, Claims Manager, Blue-E, and other electronic coding tools.
  • Provide timely response to service requests to consistently delight the customer.

Service:

  • Assures staff has a timely response to service requests through the work order system.
  • Serve on teams and tasks forces to improve organizational performance
  • Monthly audits on all assigned providers to ensure coding is accurate, documentation is complete and coding is at the highest allowable reimbursement level
  • Adherence to Pinehurst Surgical Behavioral Standards

Meets the patient’s needs first:

  • Demonstrates mutual respect and appreciation for all employees
  • Demonstrates an organizational “team” attitude
  • Provides total quality services
  • Promotes the organization and its people
  • Professional behavior
  • Seeks to improve

Qualifications

Preferred Qualifications:

  • Completion of high school or equivalent.
  • Two years of coding experience.
  • CCS, CCS-P, or CPC certification is required.
  • Advanced knowledge of medical terminology, abbreviations, techniques, and surgical procedures.
  • Maintains standards set by American Academy of Professional Coders.
  • Ability and understanding of how to use ICD-10, HCPCS, and CPT coding books and or coding tools and applications.
  • Knowledge and understanding of insurance and manage care plans.
  • Knowledge and understanding of billing and payment procedures, rules & regulations of contractual and non-contractual insurance carriers.
  • Appropriate English usage in spelling, grammar, and punctuation
  • Knowledge of basic arithmetic concepts with ability to operate standard office machines and computer and balance debits and credits.
  • Previous experience working with the public with ability to maintain composure when confronted with fast-paced and stressful situations.
  • Ability to maintain confidential information.

Personal Characteristics:

  • Well organized.
  • Service oriented.
  • Maintains confidentiality.
  • Detailed.
  • Above average communication skills.

Compensation
$21+ Depending on Experience
About Pinehurst Surgical
Pinehurst Surgical is a state-of-the-art facility located in Pinehurst, North Carolina with locations in Rockingham, Sanford, Raeford, Laurinburg, Troy and more!

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