About this role
Job Summary
Under the direct supervision of the Assistant Director of Revenue Cycle Management or Coding Supervisor, the Medical Group Coder will improve documentation, data quality and revenue cycle operations. The coder reviews and analyzes medical records to accurately select all forms of HCPCS service codes (HCPCS, CPT, CPTII, CPTIII) and ICD-10-CM codes for professional services of hospital-based surgical specialty providers. This includes services in the office or other outpatient settings and inpatient settings.
Core Job Responsibilities
- Assign the applicable HCPCS (HCPCS, CPT, CPTII, CPTIII) service codes based on review and analysis of medical records, following CMS, CPT, insurance company, hospital based and office based guidelines.
- Assign applicable modifiers, review medical necessity, CCI and other internal and external coding edits.
- Assign applicable ICD-10-CM diagnosis codes based on knowledge of ICD-10-CM, insurance company, hospital based and office based guidelines.
- Submit queries to providers, clinical staff and managers regarding incomplete, unclear, or inconsistent documentation. Re-submit queries as necessary to ensure timely resolution.
- Provide education to providers and clinical staff regarding documentation and work flow opportunities.
- Assist departments with diagnostic and procedural coding.
- Assist Business Office with insurance denials.
- Perform other duties as required.
Education/Experience Requirements
REQUIRED:
- Minimum of two years surgical based coding experience or specialty based professional credential
- Knowledge of EMR, electronic coding resources, Microsoft Office and email systems
PREFERRED:
- Completion of specialty based coding coursework or equivalent
- Knowledge of Epic, 3M ICD-10-CM and CPT software, Vitalware, Microsoft Office, Email systems
- Knowledge of CMS Teaching Physician Guidelines for Residents and Medical Students
- 2 years of hospital based, specialty based professional coding experience, or equivalent
Licensure/Certification Requirements
REQUIRED:
- CPC, CCS-P, or related AHIMA or AAPC professional specialty certification
PREFERRED:
- CPC, CCS-P, or specialty based professional credential
Disclaimer
Qualified applicants will receive consideration for employment without regard to their age, race, religion, national origin, ethnicity, age, gender (including pregnancy, childbirth, et al), sexual orientation, gender identity or expression, protected veteran status, or disability.
Successful candidates might be required to undergo a background verification with an external vendor.
Job Details
Req Id 96824
Department MEDICAL GRP ADMIN
Shift Days
Shift Hours Worked 8.50
FTE 1
Work Schedule HRLY NON-UNION-8 HR
Employee Status A1 - Full-Time
Union Non-Union
Pay Range $23 -$35 per hour
Other facts
About Mohawk Valley Health System
Faxton St. Luke’s Healthcare (FSLH) and St. Elizabeth Medical Center (SEMC) affiliated as the Mohawk Valley Health System (MVHS) effective March 2014. MVHS is governed by a single, 18-member board of directors, with nine members from FSLH’s board and nine from SEMC’s board. The system is operated by a single management team.
The MVHS serves the geographic area of Oneida, Herkimer and Madison counties and is an integrated delivery system with 4,200 full-time equivalent employees and a combined operating budget of $537 million.
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What you'll do
- The Medical Group Coder reviews and analyzes medical records to accurately select HCPCS, CPT, CPTII, CPTIII, and ICD-10-CM codes for professional services provided by hospital-based surgical specialty providers in various settings. Responsibilities also include assigning modifiers, reviewing medical necessity, submitting provider queries, and providing documentation education.
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