The Coder I will review clinical documentation to assign and sequence diagnostic and procedural codes for specific patient types to meet the needs of hospital data retrieval and billing and reimbursement. The coder may validate APC, Evaluation, and management or charge calculations in order to capture the diagnosis/procedures and/or charges documented in the clinical record. The Coder I will use standard ICD-CM, CPT/HCPCs and coding guidelines, CMS, third party and/or client specific coding guidelines. Coder I may interact with client staff and providers.
Select and sequence ICD-10 CM/PCS and/or CPT/HCPCS codes for designated patient type(s) which may include but not limited to Ancillary (Diagnostic)/ Recurring, Hospital, Clinic, Physician Pro Fee, Technical Fee, Evaluation and Management or charges.
Review clinical documentation to ensure correct coding by using correct coding guidelines and/or client specific guidelines.
Complete assigned work functions utilizing appropriate resources.
May act as a resource with client staff for data integrity, clarification and assistance in understanding and determining appropriate and compliant coding practices including provider queries.
Maintain strict patient and provider confidentiality in compliance with all HIPAA Guidelines.
Participate in client and nThrive staff meetings, training, and conference calls as requested and/or required.
Maintain current working knowledge of ICD-10 CM, CPT, HCPCS and coding guidelines, government regulations, protocols and third-party requirements regarding coding and/or billing.
Performs other related duties as assigned or requested.
Participate in continuing education activities to enhance knowledge, skills, and maintain current credentials.
Support nThrive's Compliance Program by demonstrating adherence to all relevant compliance policies and procedures as evidenced by in-service attendance and daily practice; notifying management when there is a compliance concern or incident; demonstrating knowledge of HIPAA Privacy and Security Regulations as evidenced by appropriate handling of patient information; promoting confidentiality and using discretion when handling patient and/or client information.
High School diploma or GED.
Must hold a coding credential of one or more of the following:
Active CPC-A, CPC, CCA, CCS-P, CCS, RHIT or RHIA
1+ year of professional-fee, production coding experience with or for a hospital/hospital system or physician group.
Knowledge of medical terminology, anatomy, and physiology, pharmacology, pathophysiology, as well as ICD-10 and CPT/HCPCS code sets.
Ability to consistently code at 95% threshold for quality while maintaining client-specific and/or nThrive production and/or quality standards.
Proficient computer knowledge including MS Office including the ability to enter data, sort and filter excel files, (Outlook, Word, and Excel). Demonstrates ability to navigate Internet Explorer and Microsoft Office, including the ability to input and sort data in Excel and use company email and calendar tools
Must display excellent interpersonal and problem-solving skills with all levels of internal and external customers.
Demonstrates ability to navigate Internet Explorer and Microsoft Office, including the ability to input and sort data in Excel and use company email and calendar tools.
Demonstrated success working both independently and in a team environment.
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures and/or governmental regulations.
Successfully pass pre-employment skills assessment.
Associate or Bachelor's degree.
Academic medical center knowledge.
Be Inspired. Ignite Change. Transform Health Care.
From Patient-to-PaymentSM, nThrive provides all the technology, advisory expertise, services, analytics and education programs health care organizations need to thrive in the communities they serve. Our colleagues share a united passion to help health care organizations strengthen their financial position, which translates to accessible, quality care for all. This passion fuels our drive to innovate and participate in community outreach through the nThrive CARES program. Our colleagues are encouraged to think differently and empowered to make a lasting impact that ensures our health care providers, and our world, are healthy and productive.