Medical Billing and Coding

• Follow regulatory guidelines for reporting and sequencing ICD-10-CM and PCS codes for all patient accounts
• Generate coding queries to physicians to clarify conflicting or ambiguous patient conditions in medical records
• Support quality performance measures
• Serve as a resource to the Business Office in reconciling and resolving problematic accounts
• Accurately enter ABS data, including surgeon name, procedure date, discharge disposition, admit diagnosis, and POA status
• Monitor and manage accounts receivable to drop pending, old, or problematic accounts according to the 30-Day Bill Drop policy
• Meet established bill drop dates
• Report principal and secondary diagnoses according to current AHA Coding Clinic and ICD-10-CM/ICD-10-PCS guidelines
• Work with the Coding Manager and Denial Management Coordinator to address coding denials
• Generate appropriate queries using clinical evidence and standardized templates when available
• Format non-standardized queries according to AHA Coding Clinic, CMS, and QIO guidelines
• Maintain inpatient productivity standards averaging 2 accounts per hour
• Achieve expected DRG/APC accuracy rates of 95% or higher
• Accurately report procedure codes according to AHA Coding Clinic, CPT Assistant, ICD-10-CM, CPT-4, and payer guidelines

Coder III, Medical Coding Specialist, Certified Professional Coder, Medical Billing and Coding Specialist, Inpatient Coding Specialist

• Review clinical documentation and assign diagnostic and procedural codes for outpatient, ambulatory, emergency, observation, day surgery, and other applicable encounters
• Abstract coded information into IHS RPMS and the Patient Care Component (PCC)
• Apply ICD-10-CM, ICD-10-PCS, CPT, HCPCS Level II, E/M, and NCCI guidelines
• Prioritize Medicare and Medicaid All-Inclusive Rate encounters and claims approaching timely filing deadlines
• Review records for completeness, accuracy, medical necessity, and reimbursement/regulatory compliance
• Identify documentation discrepancies and communicate with providers and staff to obtain clarification
• Resolve incomplete or delinquent records and coding-related system or documentation issues
• Assist with coding audits, compliance reviews, reimbursement-denial analysis, and performance improvement
• Maintain coding statistics, deficiency information, error reports, and required documentation
• Collaborate with clinical, Health Information Management, and Business Office staff while managing daily workload independently
• Maintain productivity and quality standards with limited day-to-day supervision
• Code approximately 1,250 patient encounters per month, or available volume
• Maintain at least a 95% coding accuracy rate
• Work aged backlog encounters according to IHS priorities, timely filing, and AIR requirements
• Communicate consistently about uncodable records, documentation deficiencies, system issues, and productivity barriers

Medical Billing and Coding jobs in Virginia

Coder III, Medical Coding Specialist, Certified Professional Coder, Medical Billing and Coding Specialist, Inpatient Coding Specialist

Medical Records Technician Coder III