Responsible for accurately assigning diagnostic and procedural codes across multiple hospital service lines, including inpatient acute, emergency, ICU, surgery, outpatient, physician clinic, swing-bed/skilled nursing, assisted living, specialty clinics, and therapy/diagnostics.
This role supports compliant, complete, and timely coding to ensure accurate claim submission, appropriate reimbursement, and regulatory compliance for a Critical Access Hospital.
Key responsibilities include:
- Assign ICD-10-CM, ICD-10-PCS, CPT, and HCPCS codes to inpatient, outpatient, emergency, surgical, and clinic encounters based on clinical documentation.
- Code across acute inpatient, swing bed, SNF, ER, observation, outpatient surgery, physician clinic, therapy, and diagnostic service lines.
- Apply revenue codes, modifiers, and occurrence/value/condition codes for UB-04 and CMS-1500 claim types.
- Ensure coding accuracy and compliance with CMS guidelines, Official Coding Guidelines, LCD/NCD policies, and CAH-specific reimbursement rules.
- Abstract and enter coded data into TruBridge in a timely manner to support billing and productivity benchmarks.
- Query providers as needed to clarify documentation for accurate and complete code assignment.
- Identify and communicate clinical documentation deficiencies to clinical staff and leadership.
- Stay current on annual ICD-10, CPT, and HCPCS updates and payer coding policy changes.
- Support coding audits, compliance reviews, and CAH cost report-related data integrity initiatives.
- Collaborate with billing staff to resolve coding-related claim edits, rejections, and denials.
Additional duties may include participation in facility committees or coding/compliance workgroups as requested.
Requirements & Qualifications
- High school diploma or equivalent required.
- Completion of an accredited medical coding program or equivalent post-secondary coding education preferred.
- Minimum 2 years of medical coding experience.
- Critical Access Hospital, community hospital, or multi-service line experience strongly preferred.
- Proficiency in ICD-10-CM/PCS, CPT, HCPCS, and revenue coding.
- Familiarity with DRG, APC, and CAH cost-based reimbursement methodologies.
- Knowledge of UB-04 and CMS-1500 claim formats.
- Experience with TruBridge or a comparable community hospital EHR/PM system preferred.
- Strong attention to detail, analytical skills, and ability to meet productivity standards.
- Preferred: Associate's degree or higher in Health Information Management or a related field.
- Preferred experience with swing bed and skilled nursing facility coding.
- Required or strongly preferred certifications: CPC, CCS, CIC, COC, RHIT, or CAH-CBS.
- Preferred certification experience: CPC, COC, CCS, or CPMA.
- Medical coding experience: 5 years required.
- Preferred specialty coding experience in physician/profee, cardiology, OB/GYN, general surgery, radiology, and urology/nephrology.
Location
N/A
Employment Type
Contractor
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
1 month ago
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