Certified Risk Adjustment Coder Jobs in Illinois

GENERAL SUMMARY

The PFS Medical Coder is responsible for the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. The coder is responsible for assigning and verifying the correct codes are used to describe the type of service(s) the patient received. The Coder will ensure the codes are applied correctly during the medical billing process, which includes removing the information from the documentation, assigning the appropriate codes, and creating a claim to be paid by the insurance carriers. Coders will work with the hospital, clinics, and physician offices as needed to provide personalized, professional healthcare services to the residents of the Communities we serve.

PRINCIPLE DUTIES AND RESPONSIBILITIES

1.    Assign codes to diagnosis and procedures, using ICD-10, CPT, and HCPS codes.

2.    Ensure codes are accurate and sequenced correctly in accordance with government and insurance regulations.

3.    Knowledge and understanding of how to properly code using medical coding books.
4.    Follow up with the provider on any documentation that is insufficient or unclear.
5.    Ensure that all codes are current and active.

6.    Ensures appropriate, accurate/timely follow-up is action taken on all denials and rejections received.

7.     Adequately responds to coding questions and provide clarification to     colleagues. 

8.    Develops and maintains appropriate communication with clinics. 

9.     Appropriately refers all non-routine issues to management for clarification.

10.    Re-code and reprocess all Denials and Rejections ensuring all avenues are explored to resolve and issues with Insurance Payers. 

11.    Ability to work with fellow staff in a professional, courteous and respectful manner at all times.

12.    Monitor CPT's and Diagnoses to assure they are coded correctly prior to billing.

13.    All other duties assigned by Director of PFS or Executive Director of Revenue Cycle.

PHYSICAL REQUIREMENTS

1.    Must be competent in the usage of PC’s keyboard, calculations, copy machine, printers and other office equipment.

2.    Light level of physical effort required for a variety of physical activities to include lifting standing and sitting at a workstation for up to four hours at a time. 

Physical strength to perform the following lifting tasks:
•    Floor to waist - 10 pounds
•    Waist to shoulder - 10 pounds
•    Shoulder to overhead - 10 pounds
•    Carry 10 pounds for 15 feet

3.    Work requires visual acuity necessary to observe and obtain information and use documentation.

4.    Auditory acuity to hear others for purposed of fluent communication.

REPORTING RELATIONSHIP

     Reports to the Director(s) of Patient Financial Services.

EDUCATION, KNOWLEDGE AND ABILITIES REQUIRED:

1.    Work requires knowledge of CPT, ICD-10, and HCPC codes.
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2.    Must hold a current unexpired CPC or CCS certification from the AAPC, NHA, or AHIMA. 

3.    2 years of previous experience with medical coding for a multi-specialty office or hospital system.

4.    Knowledge of Medical Terminology.

5.    Familiar with the Legal and Ethical Compliance with medical coding.     

6.    Previous experience in the policy and procedures of medical coding.

7.    Requires analytical skills to evaluate medical charts and records.

8.    Good communication skills to assist with coding questions and concerns from colleagues.

INFECTION EXPOSURE RISK LEVEL
Category 3 - No Risk - Your job does not involve exposure to blood, body fluids or tissue.  You do not perform or help in emergency medical care or first aid as part of your job. 
WORKING CONDITIONS

1.    Works in an office where there are relatively few discomforts due to dust or dirt.  There is some exposure to print noises.

2.    Will work in an office with co-workers where traffic may be constant, subjecting your work to interruptions, which can produce stress and fatigue.