HIM/RHC Certified Coders are responsible for reviewing, validating, and analyzing procedural coding and charging for Hospital, Ambulatory Surgical Department, Emergency Department, ancillary departments, and Clinic Services. The primary focus of the position is procedural and charge accuracy, including review of CPT and HCPCS codes, modifiers, units, revenue codes, charges, and supporting clinical documentation. Coders compare documented procedures and services with the charges and codes submitted for billing to identify missing, incorrect, duplicate, unsupported, or otherwise discrepant charges that may affect reimbursement or revenue integrity.

The position researches ICD 10, CPT, HCPCS, modifier, payer, billing, and reimbursement requirements; performs charge and coding audits; analyzes procedural claim edits and denials; and works with clinical departments, Patient Financial Services, Charge Capture, and other Revenue Cycle staff to research and resolve discrepancies. ICD-10 diagnosis coding is performed or reviewed as necessary to support accurate claims and to evaluate the relationship between diagnoses and procedures, but diagnosis coding is not the primary emphasis of the position.

Coders follow industry-standard coding and payer guidelines, Forks Community Hospital policy and procedures, and applicable billing requirements. The position also performs data analysis, reporting, research, and process-improvement activities to identify recurring procedural and charging issues, prevent revenue leakage, and improve the accuracy and completeness of claims.

QUALIFICATIONS: High School Diploma or GED required. Coding Certification (CPC, CCS-P, COC, CCS or CCA) required within 18 months of hire. Previous healthcare coding, medical billing, revenue cycle, charge capture, or health information management experience preferred. Knowledge of CPT, HCPCS, modifiers, procedural coding, charge capture, billing, reimbursement, and revenue-cycle terminology required. Working knowledge of ICD-10 diagnosis coding and medical terminology required. Knowledge of healthcare documentation and the ability to read and interpret procedure notes and other clinical documentation required. Knowledge of outpatient hospital, ambulatory surgery, emergency department, ancillary, and clinic procedures and related billing concepts preferred. Ability to identify discrepancies between clinical documentation, procedures, charges, codes, and claims. Ability to research coding, billing, payer, and reimbursement requirements and apply findings to procedural and charge-review issues. Good knowledge of English usage, grammar and spelling. Computer training and demonstrated computer experience required. Must have knowledge and experience using Microsoft Excel or comparable spreadsheet and reporting software.

Shift: Full time, M-F, 8:00am-4:30pm

SALARY: $25.65 - $40.99/hour DOE