The primary role of the Medical Coder is to abstract and identify the correct CPT and ICD-10 codes from various encounter forms and medical reports and file claims to insurance for reimbursement. The Medical Coder is responsible for assisting other staff with CPT and ICD-10 coding issues hindering expedient collection processes. Responsibilities include confirming modifier coding, utilizing sound professional coding judgment in establishing priority sequencing of diagnosis codes and services to assure maximum allowable reimbursement consistent with PDS Compliance Regulations, HCFA, Medicare, Commercial Insurance Carriers and all other regulatory agencies. The position assists in providing coding education and required documentation criteria to practitioners and staff and participates in job-related projects.
– Reviews chart documentation to support ICD-10 and CPT codes, and takes appropriate action if documentation is not supported by coding appropriately.
– Assigns appropriate codes for a 95% accuracy rate or better (quality standard).
– Analyzes and evaluates findings, diagnosis and procedure codes identified by physicians.
– Researches CPT and ICD-10 coding discrepancies for compliance and reimbursement accuracy.
– Files and follows up on Third Party claims.
– Utilizes Internet and other resources to research newly identified diagnosis and/or other procedures.
– Answers inquiries from staff and/or clients concerning CPT and ICD-10 codes.
– Prepares and performs written reports of all audits.
– Maintains strict patient and physician confidentiality and follows all federal and state guidelines for release of information.
– Maintains updated knowledge of coding requirements; including continuing education and certification renewal.
– Maintains accurate and up to date logs of discrepancies in coding trends that negatively impact collections and presents this information and innovative resolutions to the Billing Manager.
– Acts as a liaison between the CBO (Central Business Office) department, billers, and third party payers in resolving billing and reimbursement accuracy.
– Associate’s Degree in Health Information Administration, Medical Coding, or related field from an accredited college or technical school or equivalent combination of education and experience.
– +2 years of related work experience in medical coding.
– RHIT or RHIA license or CPC or CPC-P certification required.
– Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification.
– Coding course work in medical terminology, anatomy, and physiology.Desired:- Prior coursework or on-the-job training in the fields of dentistry, business, or training.
– Knowledge of WORD, EXCEL, POWERPOINT and QSI software applications.
Your commitment to Pacific Dental Services® is the key to our success. In turn, we’ll reward you with a benefits package that shows we care about you, your family and your future. We encourage team members to develop their distinctive talents and strengths—and embrace an entrepreneurial spirit that rewards individual achievement.
Location: Henderson, NV, US
Company Name: Pacific Dental Services
Pacific Dental Services (PDS) partners with individual owner dentists across the U.S., providing them with business support services so they can stay focused on their passion: dentistry. PDS and its supported owner dentists offer career opportunities nationwide. Established in 1994, PDS has been ranked in Inc.’s 500|5000 list of America’s fastest-growing private companies for eight years in a row, and continues to grow. PDS is founded on a core set of values that guides our daily lives, distinguishes the strength and character of our organization and directs our critical decisions. At PDS and in our supported offices, we aim to be the very best at everything we do. Fortunately, that helps us attract the very best team members – and we hope you’ll be one of them.