Healthcare Coder

Healthcare Coder Overview

• The Healthcare Coder will perform professional fee coding and auditing, ensuring compliance with official guidelines and maintaining accuracy in diagnosis and procedure codes.
• Validate patient demographics, insurance details, and carrier assignments to support accurate claim submissions and provider billing classifications.
• Provide physician-friendly feedback and inquiries to enhance coding and auditing processes while adhering to prescribed workflows.
• Utilize expertise in renal specialty coding to train others and maintain high accuracy rates in coding practices.
• Prepare daily coding logs, track production independently, and achieve coding production rates of 95% or above.
• Conduct claim editing activities, troubleshoot problematic accounts, and perform root cause analysis for escalations as needed.
• Maintain proficiency in ICD-10 and CPT coding, ensuring compliance and accuracy in all coding activities.
• Collaborate with revenue cycle management leadership to address escalated issues and improve coding processes.

Healthcare Coder 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 to meet organizational standards.
• Perform claim editing, troubleshoot issues, and conduct root cause analysis for problematic 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 for improved efficiency.

Healthcare Coder Job Requirements

• High School Diploma or GED required; additional certifications are preferred.
• Minimum of 3 years of coding experience required; 5 years preferred.
• Approved credential from AHIMA or AAPC, such as Certified Professional Coder, is mandatory.
• Expertise in risk adjustment coding and HCC certified coding credential is preferred.
• Proficiency in Microsoft Office applications and internet connectivity meeting specified requirements.
• Ability to work autonomously while maintaining 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.