The Certified Coder reviews, analyzes, and codes diagnostic and procedural information that determines Medicare, Medicaid and private insurance payments.  This role is responsible for coding, charge entry, Accounts Receivable (A/R) follow-up and reimbursement management.  This position also ensures compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines. 

Essential Duties and Responsibilities

• Assigns and sequences codes to diagnoses and procedures for documented information.  Assures the final diagnoses and operative procedures as stated by the provider are valid and complete.  Pulls all necessary information from health records to identify secondary complications and co-morbid conditions
• Abstracts all necessary information and assigns codes, which most accurately describe each documented diagnoses, procedure and special therapy according to established guidelines
• Determines the final diagnoses and procedures stated by the provider are valid and complete
• Performs a comprehensive review for the record to assure the presence of all component parts such as: patient and record identification, signatures and dates where required, and other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered
• Evaluates the record for documentation consistency and adequacy.  Ensures that the final diagnosis accurately reflects the care and treatment rendered.  Reviews the records for compliance with established third party reimbursement agencies and special screening criteria
• Analyzes provider documentation to assure the appropriate Evaluation & Management (E & M) levels are assigned using the correct CPT code
• Works with Clinical Operations staff to ensure that any new programs and services are billable
• Ensures all billable activities are consistent with protocols and in compliance with government and payer regulations
• Maximizes reimbursement in a cost-effective manner that is in compliance with federal/state and payer-specific billing requirements
• Serves as a key resource for changes in fee schedule and coding guidelines from all payers
• Troubleshoots, follow through and resolve issues related to the patient revenue cycle; develops and presents recommendations for further consideration by management
• Strong alignment with SCHC Mission and demonstrates behaviors aligned with SCHC Statement of Faith and Core Values
• Other duties as necessary to ensure successful attainment of SCHC goals and objectives

Job Qualifications and Requirements

• Certified Professional Coder Certificate required
• Two years’ experience in medical office coding required
• Prior experience working in mental health and substance abuse disorder billing environment preferred
• Excellent communication skills with patients and staff
• Self-motivated with strong organizational and interpersonal skills
• Proficient in computer applications – MS Word, Excel, PowerPoint, Outlook, Adobe and other office-related programs

Benefits

·       Health, Dental, Vision, and Life Insurance

·       401(K) retirement plan with employer matching contributions

·       Paid Time Off (vacation and sick)

·       Paid Holidays

Working Environment and Physical Requirements

• Work is primarily performed in an office environment but can occasionally be performed remote. Work may be stressful at times.  Interaction with others is constant and interruptive.
• Work may require sitting or standing for long periods of time; also stooping, bending and stretching for files and supplies. Occasionally lifting files or paper weighing up to 30 pounds. Requires manual dexterity sufficient to operate a keyboard, and operate office equipment as necessary.  Requires normal visual acuity and hearing
• Local travel required to attend meetings, visit other SCHC clinics, or to attend community events