Certified Medical Coder

The Certified Medical Coder plays a crucial role in the Billing Department by ensuring precise and compliant coding of medical services. Reporting to the Billing Department Supervisor, this position assigns appropriate diagnosis and procedural codes for services provided by JWCH physicians, adhering to industry standards and legal requirements. The role involves validating and auditing coding practices to guarantee accuracy in billing, supporting optimal reimbursement, and maintaining adherence to regulatory guidelines.

Responsibilities include serving as the primary liaison between providers and the Billing Department to clarify diagnoses, procedures, coding, and documentation requirements; recommending appropriate ICD-10-CM, CDT, CPT, and HCPCS codes; reviewing coding within NextGen for accuracy; collaborating with clinicians to enhance performance incentives through correct ICD-10 coding; working with the Quality Insurance Team to support Meaningful Use and clinical payments; providing compliance and coding training to new providers; ensuring all codes are current and based on medical documentation; reporting incomplete documentation; evaluating submitted codes to third-party payers and IPAs; acting as a resource for insurance and coding questions; following coding guidelines and legal compliance; supporting billing practice improvements; conducting monthly coding audits and maintaining reports; and performing other assigned duties.