Claims Edit Coder

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What you will be doing in this role:

The Claims Edit Coder (Coder II) operated under the general direction of an audit supervisor and involves responsibilities across various work units, as well as duties specific to the reporting team. In this role, the Coder II reviews ICD-10-CM diagnosis coding and Current Procedural Terminology (CPT) procedure code for claim edit fall outs. The position entails conducting modifier review and assignment, handling complex coding edits that necessitate research and resolution, and validating key data elements like the billing physician and date of service.

You are expected to abstract coded data accurately and promptly into the applicable system using relevant applications such as EPIC (CS-Link), EPIC HB and PB modules, Solventum 360Encompass, Solventum Standalone Encoder, and Select Coder. This role demands proficiency in these systems to ensure the integrity and efficiency of coding operations. Duties include:

• Review medical documentation and health information within various electronic medical or health systems.

• Assign applicable codes such as clinical modification (ICD-10-CM), current procedural terminology (CPT), evaluation and management (E&M), and healthcare common procedure coding system (HCPCS) while adhering to productivity and quality standards for the area(s) of assignment or specialty (Facility or Professional).

• Focus on specialties including, but not limited to: Professional Multispecialty E&M, Facility Emergency Room (non-Single Path), and Outpatient Visits (Facility or Professional).

• Resolve complex edits and alerts with consistent accuracy using current guidelines for the area(s) of assignment or specialty.

• Handle edits such as: Simple Visit, Local and National Coverage Determination, and other Related Edits.

• Communicates with physicians, providers, and external departments regarding documentation clarity, specificity, ensure the completeness of documentation required for code assignment within area(s) of assignment or specialty.

• Expanding skills in procedural coding such as CPT or PCS.

Originally posted on Himalayas