Company: Hoag Memorial Hospital Presbyterian
Location: Costa Mesa
Posted on: November 16, 2022
Reviews clinical documentation and diagnostic results as
appropriate to extract data and apply appropriate ICD-10-CM,
ICD-10-PCS, and/or CPT-4 codes for professional billing, internal
and external reporting, research, and regulatory compliance
activities. Resolve error reports associated with the professional
billing processes, identify and report error patterns and when
necessary assist in the design and implementation of workflow
changes to reduce billing errors. Must meet ongoing productivity
and quality metrics as established within the department for each
* Extract data from one EMR system, interpret and input into
Medical Billing system for multiple specialties
* Oversee multiple specialty practices coding work-flow to ensure
uniform processes and procedures
* Utilize technical coding principles and reimbursement expertise
to assign appropriate ICD-10-CM and CPT-4 procedure codes.
* Assign codes for diagnoses, treatment, and procedures according
to the appropriate classification system for Outpatient Procedures
and limited Inpatient Procedures, including modifier
* Review clinical notes to confirm compliance with service billing
* Ensure that claims are submitted efficiently to ensure they are
filed within the timely-filing limits of each payer
* Support the in-house billing team as requested to facilitate
* Review professional and outpatient medical record documentation
and properly identify and assign ICD-10 CM, and/or CPT-4 codes for
all reportable diagnoses and procedures:
* Determine the correct principal diagnosis, co-morbidities,
complications, secondary conditions, and surgical procedures.
* Queries physicians per established policy and procedure when
documentation is not clear or conflicting.
* Possesses a good understanding of Medicare and Medicare specific
* Meet and/or exceed the established quality standard of 95%
accuracy rate or better while meeting and/or exceeding established
* Keeps abreast of coding guidelines by self-study, assigned
education, coding meeting attendance, or related in-services.
Participates in internal and external quality review meetings
*Education, Training, and Experience*
* Required: High school diploma or equivalent. Two years of
professional coding experience or graduation from a CAHIM
accredited HIT program and is CCS eligible or RHIT eligible.
* Preferred: Successful completion of a certified coding program.
Credentials to include one or a combination of the following: CCA,
CCS, CCS-P, RHIT, and/or RHIA. CPC and/or CPC-H will be considered
with relevant outpatient coding experience.
* Required: Two years of professional coding experience including,
outpatient procedures and same-day surgery. Successful completion
of a certified coding program. Credentials to include one or a
combination of the following: CCA, CCS, CCS-P, RHIT, and/or RHIA.
CPC and/or CPC-H may be considered with relevant outpatient coding
* Required: Five years or greater of professional coding
experience. Credentials to include one or a combination of the
following: RHIA, RHIT, and/or CCS.
* Preferred: Two years of progressive OP diagnostic coding
*Skills or Other Qualifications*
* Ability to code and maintain corporate/department-specific
quality standards and meet productivity standards as documented by
the department and organization.
* Knowledge of medical terminology, anatomy and physiology, disease
process, and minor surgical procedures.
* Knowledge of accepted medical abbreviations and their
* Knowledge in the use of specialized references such as the
ICD-10-CM and CPT-4 books, medical dictionaries and texts, and
* Must have extensive knowledge of Coding Clinic, CPT Assistant,
and all official coding guidelines.
* Advanced knowledge of professional information systems, encoders,
and other technology to facilitate a successful virtual work
environment while maintaining maximum communication and adhering to
HIPAA security standards.
* Advanced knowledge of MS Excel, Word, and Outlook functions.
* Abides by the Standards of Ethical Coding as set forth by the
American Health Information Management Association (AHIMA) and
adheres to all official coding guidelines.
* Technical skills required to learn and navigate a variety of
software systems, troubleshoot computer problems, install periodic
updates to software programs, and work efficiently in a virtual
* Strong written and verbal communication skills.
* Ability to think/work independently yet interact positively with
a remote team.
* Advanced problem-solving skills.
* Familiarity with current healthcare-based technology, coding, and
Electronic Health Record (HER).
* Attention to detail is crucial to this position.
* Knowledgeable in Revenue Cycle department functions relating to
Ambulatory Payment Classification (APC) grouping, denials, and
*License and Certifications*
* Required: See Above by Level
* Preferred: See Above by Level
Job Type: Full-time
* 401(k) matching
* Dental insurance
* Disability insurance
* Health insurance
* Life insurance
* Paid time off
* Tuition reimbursement
* Vision insurance
* 8 hour shift
* Monday to Friday
Work Location: One location
Keywords: Hoag Memorial Hospital Presbyterian, Costa Mesa , Medical Coder, Healthcare , Costa Mesa, California
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