Overview

The Clinical Coder is responsible for reviewing medical record documentation and assigning codes for reimbursement and statistical purposes.

Responsibilities

Maintain working knowledge of coding fundamentals, including ICD-9-CM, HCPCS, CPT-4, and Evaluation and Management coding for inpatient, outpatient, and physician services.
Maintain knowledge of official coding guidelines, including Coding and Reporting guidelines, AHIMA Coding Clinics, and AMA CPT Assistant.
Maintain knowledge of reimbursement rules related to coding, including prospective payment systems and third-party medical billing requirements.
Assign codes based on medical record documentation and request clarification from physicians when documentation is unclear, illegible, or conflicting.
Maintain a high level of accuracy and productivity in coded claims.
Maintain knowledge of coding compliance requirements.
Work with the Business Office to reconcile denied claims related to coding issues.
Use the HBOC and 3M systems.
May perform coding audits for quality checks.
May provide physician education.
Perform other related duties as assigned.

Qualifications

Minimum of 2 years of coding experience.

Bachelor’s degree, or an associate degree with successful completion of the RHIA or RHIT examination approved by AHIMA for inpatient or hospital outpatient coding.

One of the following certifications is required or accepted for the appropriate coding specialty:

CCS
RHIA
RHIT
CPC-H
CCS-P
CPC
CCA

Applicants with a CCA certification must obtain advanced certification as a CCS, CPC-H, CCS-P, or CPC within 5 years of hire, depending on coding specialty.

Must successfully complete ARH coding assessments prior to employment, including coding directly from sample patient charts.