Healthcare Coder

Overview

• Perform professional fee coding and auditing to ensure compliance with official coding guidelines and accuracy in diagnosis and procedure codes.
• Validate patient demographics, insurance details, and carrier assignments to ensure proper claim submission and provider billing group classification.
• Compose physician-friendly feedback and inquiries following prescribed workflows to support coding and auditing processes.
• Utilize expertise in renal specialty coding and auditing to train others and maintain high accuracy rates.
• Prepare daily coding logs, track production independently, and achieve a coding production rate of 95% or above.
• Conduct claim editing activities, troubleshoot problem accounts, and perform root cause analysis for escalation as needed.
• Maintain proficiency in ICD-10 and CPT coding with an accuracy rate of 95% or above.
• Collaborate with revenue cycle management leadership to address escalated issues and improve processes.

Key Responsibilities & Duties

• Analyze and review medical records to ensure accurate code assignment for professional fee charts.
• Validate clinical code assignments and prepare claims for submission with correct provider billing group classifications.
• Compose compliant, physician-friendly feedback for provider inquiries and code validation audits.
• Track and maintain coding production rates and accuracy metrics independently.
• Perform claim editing, troubleshoot issues, and conduct root cause analysis for problem accounts.
• Utilize expertise in renal specialty coding to audit, code, and train others effectively.
• Ensure compliance with coding guidelines and maintain high accuracy in ICD-10 and CPT coding.
• Collaborate with leadership to address escalated issues and enhance coding processes.

Job Requirements

• High School Diploma or GED required; additional certifications preferred.
• Minimum of 3 years of coding experience; 5 years preferred.
• Approved credential from AHIMA or AAPC, such as Certified Professional Coder.
• Expertise in risk adjustment coding and HCC certified coding credential preferred.
• Proficiency in Microsoft Office applications and internet connectivity meeting specified requirements.
• Ability to work autonomously and maintain high accuracy and production rates.
• Experience in renal care, value-based care, or startup environments is advantageous.
• Strong communication and analytical skills with a focus on compliance and accuracy.