Coder

This is a fully remote position, open to applicants in Rhode Island.

📋 Description

• Review, analyze, and assign ICD-10-CM, CPT, and HCPCS Level II codes for services provided by physicians and qualified healthcare professionals.

• Input coded and abstracted data into the 3M 360 Finder.

• Accurately assign APC codes and evaluate coding edits within 3M.

• Adhere to NCCI edits and medical necessity guidelines.

• Resolve accounts within the claims edit database.

• Allocate injection and infusion codes for observation patients.

• Maintain an average coding accuracy of 95% and comply with productivity benchmarks.

• Assign E/M, ICD-10-CM, CPT, and chargemaster codes for clinic visits.

• Validate physician-entered diagnoses, ICD, and CPT codes against medical record documentation.

• Detect and resolve NCCI edits prior to billing completion.

• Communicate documentation deficiencies to relevant physicians.

• Follow Rhode Island Hospital’s coding guidelines for adult patients and the 1995 E/M guidelines for patients under 18.

• Monitor and address rejected accounts on Claims Edit Reports and eClinicalWorks error reports.

• Investigate coding discrepancies related to chargemaster, medical necessity, and billing matters.

• Refer intricate coding situations to the coding validator or supervisor.

• Assess outpatient uncoded reports and rectify outdated or inappropriate accounts.

• Update patient financial records in the Patient Management and Patient Accounting systems.

• Rebill accounts in accordance with established protocols.

• Execute related clerical tasks.

• Keep abreast of current coding knowledge and expertise.

• Engage in compliance initiatives aimed at minimizing coding denials and audit findings.

• Ensure adherence to coding, privacy, security, payer, and organizational standards.

• Precisely resolve coding edits, denials, and discrepancies.

• Operate independently and participate in scheduled virtual meetings.

⛳️ Requirements

• High school diploma or equivalent is mandatory.

• One or more certifications are required: CPC (Certified Professional Coder) – AAPC; CCS or CCS-P (Certified Coding Specialist / Physician-based) – AHIMA.

• 1–3+ years of experience in professional physician-based coding.

• Specialty experience is advantageous.

• Comprehensive understanding of ICD-10-CM, CPT, and HCPCS Level II coding regulations.

• Familiarity with medical terminology, anatomy, and healthcare documentation.

• Capability to interpret intricate medical documentation and accurately apply coding guidelines.

• Excellent written and verbal communication abilities.

• Proficient in electronic health records (EHR); experience with Epic is preferred.

• Background in E/M coding and/or surgical/procedural coding is beneficial.

• Must maintain a secure and private workspace to safeguard PHI.

• Required to utilize organization-approved secure systems, VPN, and multi-factor authentication.

• Ability to meet deadlines while sustaining productivity and accuracy standards.

• Capacity to work autonomously within departmental policies and practices.

• Ability to escalate complex issues to a supervisor for clarification as needed.

• No supervisory responsibilities involved.

• Must comply with CMS regulations, NCCI edits, MAC guidance, payer policies, organizational policies, HIPAA, data privacy and security policies, ACDIS/AHIMA query guidelines, and ethical coding standards.

🏝️ Benefits

• Fully remote work arrangement.

• Organization-approved secure systems, VPN, and multi-factor authentication.

• Virtual meetings and communication platforms.

• Day shift schedule from 8 AM to 5 PM.

• Commitment to equal employment opportunity and a harassment-free work environment.