Position Summary
The Coder is responsible for reviewing, analyzing, and assigning appropriate diagnostic and procedural codes to ensure accurate billing and reimbursement from Medicare, Medicaid, and private insurance carriers. This position supports the revenue cycle through accurate coding, charge entry, A/R follow-up, and reimbursement monitoring while ensuring compliance with payer guidelines and accreditation standards.
Essential Duties and Responsibilities
• Accurately assign and sequence diagnosis and procedure codes based on documentation provided by clinical staff.
• Verify that all provider-documented diagnoses and operative procedures are complete and valid.
• Abstract relevant clinical data and assign CPT, ICD-10, and HCPCS codes in accordance with coding guidelines.
• Conduct thorough chart reviews to ensure completeness, accuracy, and documentation compliance.
• Ensure final diagnoses reflect care and services rendered and are supported by medical record documentation.
• Review charts for coding consistency, compliance, and third-party payer guidelines.
• Evaluate and assign correct Evaluation & Management (E/M) levels using appropriate CPT codes.
• Collaborate with Clinical Operations to ensure new programs/services are properly structured for billing.
• Monitor regulatory and payer policy changes; ensure SCHC maintains compliance with coding and billing updates.
• Serve as a resource on billing, coding, and reimbursement issues including troubleshooting and resolution.
• Ensure coding maximizes reimbursement in accordance with federal, state, and payer-specific billing rules.
• Support the SCHC mission and model behavior consistent with SCHC’s Statement of Core Values.
• Perform other duties as assigned to support SCHC’s strategic goals.
Job Qualifications and Requirements
• Certified Professional Coder (CPC) credential preferred.
• Minimum of two (2) years medical coding experience in a healthcare or outpatient clinical setting required.
• Experience in behavioral health or substance use disorder billing preferred.
• Strong knowledge of CPT, ICD-10, HCPCS, and E/M coding guidelines.
• Excellent attention to detail, analytical skills, and problem-solving ability.
• Proficient in Microsoft Office (Word, Excel, PowerPoint, Outlook) and EHR systems.
• Effective written and verbal communication skills.
• Organized, self-directed, and able to manage multiple priorities.
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 Physi