Medical Coder II

Job Summary:

• Serves as the primary resource for medical coding updates and information.
• Advises client on coding issues, provides in-depth research on new or unusual procedures, and makes recommendations when appropriate.
• Provides support to the Claims and Provider Relations Departments.

Duties and Responsibilities:

• Reviews and researches billed unlisted procedure codes to determine if a more specific code exists.
• Supplies cover and pricing information to client Medical Director regarding unlisted codes.
• Conducts meetings with state client to discuss procedure code coverage and ensures coding decisions are implemented.
• Responsible for archiving all Procedure Code Workgroup (PCW) agendas, minutes, and related materials.
• Maintains HIPAA reason and remark code lists and provides code updates to the HIPAA Code Workgroup, when necessary.
• Supports the Claims Department by working edit reports as assigned.
• Provides Provider Relations with coding issues and updates to be shared with providers to ensure timely and accurate claim payment.
• Maintains a library of code books and relevant resources to be available to personnel, when necessary.
• Serves as a resource for the client and co-workers with question related to coding issues.

Education:

• Bachelors Degree or equivalent experience.
• Associates degree or equivalent combination of education and experience.

Experience:

• 2-4 years in professional coding experience, professional or hospital.
• More than 2 years experience in a healthcare setting.
• More than 2 years experience in coding and medical record chart review.

Licensure/Certification:

• Active and unrestricted Coding Certification (CIC, CPC, CCS, RHIT, or RHIA).

Knowledge/Skills/Abilities:

• Proficient in MS Office Suite.
• Knowledge of insurance claims processing.
• Ability to work independently, with minimal supervision.
• Excellent verbal and written communication skills.
• Ability to abide by Clients policies.
• Ability to maintain attendance to support required quality and quantity of work.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers.