Medical Coder IV

Work Shift

Scheduled Weekly Hours

Summary

Job Description

Job Duties

• Codes the correct principal/primary diagnosis consistent with established coding guidelines (95% or greater accuracy).
• Identifies all significant diagnoses (complications and co-morbidities/HCCs) relevant to the type of visit and assigned appropriate codes.
• Codes procedures as appropriate and identifies the principal procedure consistent with established coding guidelines.
• Ensures all conditions coded adequately reflect the appropriate clinical severity and grouping assignment in accordance with documentation.
• Follows official coding guidelines and directives and uses reference materials to ensure codes assigned are in compliance with state and federal regulations.
• Validates accounts for medical necessity based on local medical review policies (LMRPs), national coverage determinations (NCDs), or payer guidelines.
• Researches and validates claim edits and denials appropriately.
• Obtains clarification and/or collaborates with the Provider, Clinical Documentation Specialist, and/or Internal Coding Auditor to improve overall quality and completion of clinical documentation in patient records to ensure accurate and complete coding.
• Applies charge data as appropriate for services provided. Verifies level of service charged is supported by accompanying documentation.
• Completes coding consistent with established production standards for type of service.
• Verifies and corrects all abstract data captured.
• Assists with new hire and current staff training as well as student internship coding training.
• Follows Mercy's safety guidelines, carries out job-specific safety duties and responsibilities, and promptly reports any unsafe conditions, situations, incidents and injuries.

Department Specific Duties

• For hospital services – Codes for 3 or more specialty services (e.g. inpatient, emergency, home health, outpatient surgery, observation).
• For professional services - Codes 50% of more of time with specialty services (e.g. surgery, hematology/oncology, cardiology) or coordinates special projects/teams (e.g. provider newsletter, denials team).

Knowledge, Skills and Abilities

• Knowledge of ICD-10-CM/PCS and CPT/HCPCS coding and medical necessity guidelines.
• Knowledge of various coding groupers used for various payers and types of encounters.
• Ability to read and interpret medical record documentation including laboratory and pharmacology data.
• Knowledge of Microsoft Office tools (excel, outlook, word).
• Strong computer background with basic typing and keyboarding skills.
• Work prioritization skills needed.
• Ability to concentrate on detailed tasks for long periods of time.
• Ability to work independently with frequent interruptions.
• Excellent interpersonal communication (verbal, non-verbal, and listening) skills and written communication skills.
• Knowledge of hospital payment systems and federal and state regulations related to billing, coding, and compliance.

Professional Experience

• Five years previous coding experience required.

Education

• Education sufficient to obtain certification.

Licensure, Certification, Registration

• AHIMA or AAPC coding certification (e.g. RHIT, RHIA, CCA, CCS, CCS-P, CPC) is required.

Pay Rate Type

Mercy is an independent, community-based organization supporting the Cedar Rapids area for over 120 years.

Mercy is an equal-opportunity employer. We value diversity, equity, and inclusion and therefore evaluate qualified applicants without regard to race, color, ethnicity, ancestry, sex, sexual orientation, gender identity, marital status, civil union status, parental status, religion, national origin, age, disability, veteran status, and other legally protected characteristics.