Medical Coder I

JOB SUMMARY

This role is primarily responsible for coding procedures, diagnoses, and modifiers, ensuring accurate CPT and ICD-10 code assignments within the practice management system/electronic medical records (EMR).

ROLES AND RESPONSIBILITIES

1. Accurately code the medical records using appropriate CPT, ICD-10, and modifier codes.
2. Review the discharge summary, history and physical, physician progress notes, consultation reports, radiology, laboratory, pathology, operative records, emergency room record and any other pertinent documentation to accurately assign diagnoses and/or procedures.
3. Determine diagnoses that were treated, monitored, and evaluated and procedures done during the episode of care and assign appropriate codes.
4. Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations.
5. Ensure the diagnoses and procedures are sequenced in order of their clinical significance to accurately assign the appropriate DRG, APC or payment tier under the Prospective Payment system to guarantee accurate reimbursement. Review coding for accuracy and completeness prior to submission to billing.
6. Abstract required medical and demographic information from the medical record and enter the data into the system to ensure accuracy of the database. Responsible for correcting any data found to be in error after reviewing the medical record and comparing with system entries.
7. Ensures all required component parts of the medical record that pertain to coding are present, accurate and comply with CMS, JCAHO, and client requirements. Identify incomplete or conflicting documentation in the medical record and formulate a physician query to obtain missing documentation and/ or clarification to accurately complete the coding process. Utilize computer applications and resources essential to completing the coding process efficiently.
8. Maintain compliance with medical coding standards, guidelines, and regulations.
9. Ensure claims are coded properly to avoid denials and ensure clean claim submission.
10. Meet or exceed goals and benchmarks related to accuracy and efficiency as set by the client.
11. Communicate effectively with internal teams to resolve any coding discrepancies.
12. Performs other tasks that may be assigned from time to time.

JOB REQUIREMENTS

1. Bachelor's degree in health information management or related Allied Health discipline. Nursing graduate is preferred.
2. Minimum of 1 year in medical coding
3. Experience with coding multi-specialty charts
4. CPC, COC, or CCS or equivalent is required.
5. Strong knowledge of medical terminology, CPT coding, and ICD-10 codes
6. Proficient in the use of practice management system, EMR, and billing systems
7. High level of accuracy and attention to detail
8. Ability to manage multiple tasks and deadlines efficiently
9. Familiarity with Microsoft Office Suite (Outlook, Word, Excel)
10. Excellent communication skills and the ability to collaborate in a team environment
11. Comfortable using email, web browsers, and general computer systems

Work arrangement: Work in the office during Training to Speed-To-Proficiency; Hybrid during full production

Schedule: Night-shift, and/or Mid-shift

Office location: Alabang Corporate Center