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Primary Health Care Coder II in Des Moines, Iowa

Job Summary

The Coder II is responsible for reviewing and analyzing medical records and charge tickets to determine appropriate assignment of ICD-10-CM, CPT and HCPCS codes to reflect patient diagnoses and procedures. Analyzes claim denials; taking appropriate steps to correct the claim and to initiate changes in process. In coordination with the Medical Director, provides feedback to medical and ancillary staff regarding appropriate documentation and code assignment. Ensures compliance with all legal and procedural requirements.

Essential Functions

  • Reviews and analyzes medical records and charge tickets to assign and sequence ICD-10-CM, CPT and HCPCS codes for services rendered.

    1. Monitors status of patient encounters for appropriate code assignment and works to expedite final billing.
  • Complies with all legal requirements regarding coding procedures and practices.

  • Communicates with and educates medical and ancillary staff, as necessary, concerning diagnoses and procedures noted in the medical record.

  • Maintains the timeliness of coding tickets as defined and set forth by the Chief Financial Officer.

  • Serves as a reference source to Coder I, medical and ancillary staff with regard to ICD-10-CM, CPT and HCPCS coding systems.

  • Collaborates with billing to ensure all bills are satisfied in a timely manner.

  • Analyzes payer denials and takes appropriate steps to resolve coding errors and disputes including communication with insurance companies.

  • Identifies opportunities to improve the claim process. Works with Coding Manager and Clinic Administrators to implement process improvements.

    Characteristic Duties of All Primary Health Care Employees

  • Demonstrates PHC iCare values of Integrity, Compassion, Access, Respect and Excellence in all interactions.

  • Leads by example.

  • Provides excellent customer service to all customers.

  • Improves work processes and clinical outcomes including disparity and quality improvement initiatives.

  • Follows PHC’s policies and procedures and reports needed changes.

  • Develops and maintains own competence including completion of all assigned training within assigned deadlines.

  • Establishes and maintains positive working relationships with team members.

  • Maintains a safe working environment and practices safe working habits.

  • Protects patients’ rights by maintaining patient confidentiality per HIPAA and the PHC Corporate Compliance Program.

  • Participates in cross training and works as a team to facilitate patient care.

  • Attends department meetings, training programs, and committee meetings as requested.

  • Consistently meets assigned work schedule.

  • Performs other duties as assigned.

    Minimum Qualifications

    Education: High school diploma or equivalent.

    Experience: None required.

    License/Certifications: Professional certification by the American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC)

    Knowledge, Skills or Abilities:

  • Working knowledge of ICD-10-CM

  • Effectively use the ICD 10-CM, CPT and HCPCS reference books

  • Proficiency in operating a computer and ability to learn and use computer applications

  • Knowledge of third party payers and associate regulations

  • Effective verbal and written communication skills

  • Superior mathematical skills

  • Problem solving and analysis skills

  • Organizational skills

  • Attention to detail

  • Teamwork and collaboration skills

  • Strong analytical and critical thinking skills

    Other Job Requirements:

    Must be at least 18 years of age

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