The Certified Medical Coder will serve as the primary resource for medical coding updates and information. You will advise client on coding issues, provides in-depth research on new or unusual procedures, and makes recommendations when appropriate and provide support to the Claims and Provider Relations Departments.

Responsibilities:

·         Review and research billed unlisted procedure codes to determine if a more specific code exists. 

·         Supply cover and pricing information to client Medical Director regarding unlisted codes.

·         Conduct meetings with state client to discuss procedure code coverage and ensure coding decisions are implemented.

·         Own archive of all Procedure Code Workgroup (PCW) agendas, minutes, and related materials.

·         Maintain HIPAA reason and remark code lists and provide code updates to the HIPAA Code Workgroup, when necessary.

·         Support the Claims Department by working edit reports as assigned.

·         Provide Provider Relations with coding issues and updates to be shared with providers to ensure timely and accurate claim payment.

·         Maintain a library of code books and relevant resources to be available to personnel, when necessary.

·         Serve as a resource for the client and co-workers with question related to coding issues.

Requirements:

·         Associates or BA/BS preferred

·         AHIMA certification preferred

·         Experience with bundling software

·         Terminology expertise preferred:  diseases, pharmacology, general medical

·         Understanding of the surgical section of CPT and ICDCM in order to properly convert terminology into numerical codes

·         Proficiency in assigning accurate medical codes throughout a wide range of services

·         Experience in integrating coding and reimbursement rule changes

·         Experience with AHA coding clinic guidelines

·         Knowledge of anatomy, physiology and medical terminology necessary to correctly code provider services and diagnoses is important

·         Proficient in  MS Office Suite

·         Ability to work independently, with minimal supervision

·         Excellent verbal and written communication skills

We are an equal opportunity employer and provide excellent health benefits, 401K and an opportunity to participate in our company employee purchase plan!!!