Job Description
Role Summary:
Medical Coding is the process where the medical record and claim documentation are checked and medical diagnostics, treatments and procedures (medical services) are converted to universal alphanumeric codes. This is one of the intermediate steps in processing claims. These codes form part of data collection which is used in research, funding and healthcare planning.
The Associate Coder is responsible for applying the relevant coding to the claims based on the individual providers manual and as per the coding rules governing the specific compliance in relation to coding guidelines for the specific geographical area.
Primary Responsibilities:
- Analyzing and auditing of claims for completeness with relation to medical information and insurance coverage for services rendered.
- Applying the relevant code sets, keeping in mind the trends for denials and non-payments in relation to detailed data needed to describe and notify services as rendered within the Insurance scenario.
- Understand the individual client payer contracts so as be able to process claims in submission and resubmission based on the same.
- Be able to process claims in OP scenario.
- Analyze and communicate coding and billing issue of the provider to the supervisors.
- Have complete knowledge of billing guidelines of the provider and payer.
- To assist with documentation review and raise queries on completeness of EMR.
- The Coder must undertake a thorough review of applicable documentation to assess the documentation requirement and determine the appropriate ICD-10-CM and/or CPT-4/USCLS codes to be reported, in conjunction with the applicable version of Official Guidelines
- Must observe AHIMA code of ethics while assigning relevant code sets.
Job Requirements:
- Accurately assign medical codes to outpatient services using ICD-10-CM, CPT, and HCPCS coding guidelines.
- Review medical records to ensure documentation supports the assigned codes.
- Communicate with healthcare providers to clarify documentation and obtain additional information as needed.
- Stay updated on coding guidelines and regulations to ensure compliance with industry standards.
- Maintain a high level of accuracy and productivity in coding assignments.
- Adhere to confidentiality and privacy regulations to protect patient information.
- Collaborate with other members of the coding team to resolve coding-related issues.
- Assist with coding audits and provide feedback for improvement.
- Participate in continuing education and professional development activities to enhance coding skills.
- Stay informed about changes in healthcare regulations and reimbursement policies.
