OP Medical Coder

• Codes Outpatient Claims by assigning the appropriate E&M, CPT, ICD and USCLS Codes.
• Codes Inpatient Claims so as to derive the most appropriate DRG Codes and severity.
• Codes for all Day cases and Observations with relevant ICD, CPT, HCPCS and Service Codes.
• Codes for all Inpatient and Outpatient approval requests.
• Re-evaluates the cases in terms of coding, at the time of resubmission; to add, delete or change certain codes, as per the available documentation; in order to justify the performed services.
• Provides orientation to new Doctors and Nursing staff, with regards to documentation of cases on the Patient/Medical records.
• Assists Doctors with regards to codes, in order to help them document the cases in a most appropriate manner, so as to include all the essential requirements.
• Provides Coding assistance to the Insurance billing team as per requirement.
• Addresses all Coding queries from the Billing, Laboratory and Radiology departments of the facility.
• Follows up with doctors, with regards to incomplete Medical Record files, in order to complete the same.
• Prepares the facility for the Coding Audits for accreditation and implements all the mandates set by DOH and CCSC.
• Maintains statistical data with regards to Coding and presents the same to the HOD and Management, as and when requested.
• Achieves accuracy in coding so as to attain maximum revenue.
• Assists Auditors at the time of Insurance audits and helps the Insurance Manager in preparing feedbacks and reports for the same
• The coder must clarify ambiguities and highlight inconsistencies found in diagnosis described in the Medical records to physicians with escalation to the HOD. All clarifications must be documented.
• Adhere to the hospitals telephone standards

Desired Candidate Profile

• Any Bachelor degree (preferably with Medical background)