Prairie Ridge Health is looking for a team member to join our Medical Records Department in the role of Coding Specialist. This position is a 1.0 FTE (40 hours per week).  Candidates must be within an hour drive of the hospital location. Training will take place in person and the position will be remote after the training period but require in-person attendance for meetings, etc. 

POSITION SUMMARY

The Medical Coding Specialist is primarily responsible for assigning diagnosis (ICD-10), CPT procedure codes to hospital and clinic medical records as well as professional charging for ER/UC and Clinic encounters utilizing facility and payer guidelines.  This position will also resolve Claim Edits and work with billing to resolve all insurance denials related to coding and charging.  This role must have a strong understanding of payer policies, Local Coverage Determinations (LCD), and National Coverage Determinations (NCD) for successful claim submissions. This position serves as a coding resource for all hospital departments and communicates regularly with Business Services and Registration departments to ensure claims are submitted and reimbursed promptly and accurately.  This position provides education to physicians regarding documentation and coding best practices. It is essential to understand the life cycle of billing a claim and how to improve the revenue cycle.  

POSITION SPECIFIC FUNCTIONS

Utilize 3M encoder, grouper software, and other coding resources to determine the appropriate ICD-10-CM, CPT, and/or HCPCS including specialty specific codes

 and Evaluation and Management (E&M) codes.

Maintain an understanding and apply knowledge of National Correct Coding Initiatives (NCCI), Local Coverage Documents and National Coverage Documents (LCD/NCD) directives.

Maintain an understanding and apply knowledge of Medically Unlikely Edits (MUEs), and applicable regulatory requirements as well as payer guidelines to select appropriate codes and modifiers.

Must have a solid understanding of insurance policies and procedures to ensure accurate billing and coding and able to navigate insurance company portals to access the necessary information.

EDUCATION REQUIREMENTS/LICENSURE/CERTIFICATION/REGISTRATION

High School Diploma or equivalent and medical coding education required.

Active Coding Certification required.

Minimum one year of medical coding experience with an emphasis in diagnosis/procedures coding and E&M charging for facility (hospital) and professional claims required.

Associate’s degree in a healthcare related field preferred

EPIC experience preferred

Certifications accepted and required upon hire: 

Certified Professional Coder (CPC)

Certified Outpatient Coder (COC)

Certified Inpatient Coder (CIC)

Certified Coding Specialist (CCS)

Certified Coding Specialist Physician-Based (CCS-P)

Registered Health Information Technician (RHIT)

Registered Health Information Administrator (RHIA)

Shift: Monday-Friday, days. Candidates must be within an hour drive of the hospital location. Training will take place in person and the position will be remote after the training period, but require in-person attendance for meetings, etc. 

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