Certified Medical Coder

Certified Medical Coder.fy26.docx

Position Title: Certified Medical Coder

Division: Oyate Health Center

Reports To: Sr VP/CFO

Job Summary:

Primary responsibilities of the certified medical coder duties in support of the Oyate Health Center (OHC) Patient

Accounts Department, facilitating and is responsible for converting medical diagnosis, supplies and processes into

standardized codes that are used when filing insurance claims, to ensure compliance with Medicare, Medicaid, and private insurance rules and regulations.

Specific duties include, but are not limited to:

• Knowledge of Health Insurance Portability and Accountability Act (HIPAA) and Health Information Technology for Economic and Clinical Health Act (HITECH).

• Knowledge of medical records requirements and functions.

• Knowledge of ICD-10 (International Classification of Diseases), CPT 4 (Current Procedural Technology) and HCPCS (Healthcare Common Procedure Coding System) coding guidelines.

• Analyzes and abstracts all necessary information from the record to reflect secondary complications and comorbidity conditions.

• Codes diagnosis and/or procedures from the medical records, and assures the final diagnosis and procedures as stated by the medical provider are valid and complete.

• Codes complex and difficult records accurately; makes complete and accurate selection of the principal diagnosis and principal procedure/operation; diagnosis codes are sequenced properly; and assures that all orders (medication, lab, and radiology) have been documented properly to support level of services and reflect the medical necessity for the order.

• Assures the presence of all components of the record, including correct identification, health record number, signatures, dates, accurate and complete notes (chief complaint, history of present illness (HPI), review of systems, examination, and assessment and plan are completely documented.

• Examines the level of services to ensure it is accurate and appropriate for the documentation in the note and when appropriate modify level of service.

• Completes medical record by reviewing information; notifying health care providers of record deficiencies; tracking outstanding records; and resolves medical record discrepancies by collecting and analyzing information.

• Incumbent works independently. Takes the initiative to communicate with Providers and Billing staff on coding/documentation issues.

• Participates on performance improvement teams and other committees as assigned.

• Must comply with federal laws and regulations as required by the Health Insurance Portability and Accountability Act (HIPAA).

• Performs related duties.

• Performs the core responsibilities of the position accurately, timely, and in accordance with established standards.

• Maintains regular and reliable attendance consistent with the position’s schedule and operational needs.

• Communicates effectively with internal and external stakeholders as required by the role.

• Adheres to all applicable policies, procedures, and regulatory requirements.

• Utilizes required systems, tools, and technology necessary to perform the job.

Minimum Qualifications

Education/Relevant Experience: Completion of a formal training program or an associate’s degree and one (1) year of relevant experience; or a high school diploma or GED and three (3) years of relevant experience.

Certification: Certified Medical Coding Certification

Individuals must have applicable education or experience applying a body of standardized rules, procedures, or operations to perform the full range of standard clerical assignments and resolve recurring problems or to operate and adjust varied equipment for purposes such as performing numerous standardized tests or operations.

The GPTCHB is a tribal organization which follows tribal preference laws. It is our policy to give preference to qualified Indian/Tribal candidates over a qualified non-native candidate in hiring decisions, if all other qualifications are equal.

Employment is contingent upon the outcome of all required criminal background checks and pre-employment drug screen.

Compliance with our Employee Health Procedure is a condition of employment. You are required to agree that you will comply with all job-related employee health screening and immunizations prior to your first day of employment. Jobs require that you have documentation that you have completed the following immunizations prior to your first day of employment: MMR (Measles, Mumps and Rubella, Varicella (Chicken Pox), Hepatitis B, Influenza, T-dap (Tetanus - Diphtheria - Pertussis), and COVID-19 vaccination is required.

This position requires the ability to perform the essential functions of the job, with or without reasonable accommodation. Physical demands and work environment may include:

• Primarily sedentary work is performed in an office or administrative setting.
• Requires the ability to sit for extended periods and regularly use standard office equipment such as a computer, keyboard, telephone, and copier.
• Occasional standing, walking, bending, and reaching may be required.
• Ability to lift and carry office materials or supplies up to 25 pounds occasionally.
• Requires manual dexterity and visual acuity for computer use and document review.
• Must be able to read, write, speak, and hear.
• Work is performed primarily in an indoor office or administrative environment.
• The environment involves everyday risks or discomforts that require normal safety precautions typical of office settings, including proper use of office equipment and awareness of trips, falls, and fire regulations.
• The work area is adequately lighted, heated, and ventilated.
• Minimal exposure to hazardous conditions; no routine exposure to clinical, field, or high risk environments.
• Occasional attendance at meetings, training sessions, or events may require travel within the organization's facilities.

The employee must comply with all organizational policies, procedures, and applicable laws and regulations. This position is subject to Native Preference, background checks, health requirements, and other applicable organizational standards.