Coder
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Requirements
• Active coding certification required (CPC, CCS, CCS-P, or equivalent). • Minimum of five (5) years of professional medical coding experience, in OB/GYN within a physician billing or revenue cycle environment. Prior experience in a lead, audit, quality assurance, or mentoring role preferred. • Advanced knowledge of ICD-10-CM, CPT, and HCPCS coding guidelines, including specialty-specific rules for OB/GYN. • Thorough knowledge of CMS, Medicaid, and commercial payer requirements, including fraud and abuse regulations. • Strong working knowledge of Electronic Health Records (EHR) and physician billing systems. • Full knowledge of HIPAA regulations and confidentiality standards. • Demonstrated leadership, coaching, and communication skills. • ∙ Skill and ability to communicate effectively both verbally and in-writing. • ∙ Ability to present information clearly to staff, providers, and leadership. • ∙ Ability to perform basic mathematical calculations, including percentages and data tracking. • ∙ Proficiency in physician billing systems, EHR platforms, and Microsoft Office applications • ∙ Ability to effectively use payer portals, coding tools, and online resources. • ∙ Ability to professionally support providers and internal stakeholders with timely, respectful communication. • DISCLAIMER • The above information is intended to describe the general nature and level of work being performed by people assigned to this job. It is not intended to be an exhaustive list of responsibilities, duties and skills required of personnel so classified. Examples listed do not preclude the performance of other duties similar in nature or in level of complexity.
Responsibilities
• Reviews and validates professional coding for OB/GYN and behavioral health services prior to charge entry or approval. • Ensures accurate assignment of diagnosis and procedure codes, modifiers, and units in compliance with CMS, OIG, and payer guidelines. • Provides routine coding audits and quality reviews; provides targeted feedback and education based on findings. • Identifies documentation gaps, denial trends, and compliance risks and recommends corrective actions. • Appropriately queries providers for missing, conflicting, or unclear documentation. • Reviews and resolves coding-related claim rejections and denials. • Ensures all services meet medical necessity and documentation requirements prior to billing. • Coordinates with AR, billing, CDI, and revenue cycle teams to support timely claim resolution. • CORE REVENUE CYCLE FUNCTIONS: • ∙ Complies with Revenue Cycle policies and procedures. • ∙ Provides daily leadership, mentorship, and support to assigned coding staff. • ∙ Serves as the primary escalation point for complex coding and specialty-specific questions. • ∙ Assists with onboarding, training, and ongoing education of coding staff. • ∙ Fosters a collaborative, accountable, and performance-focused team environment. • ∙ Monitors team productivity, quality, and turnaround time benchmarks. • ∙ Assists with workload distribution and prioritization across specialties. • ∙ Supports performance improvement initiatives and corrective action plans. • ∙ Works special projects assigned by Manager, Director, or Revenue Cycle leadership. • This list is not meant to be restrictive, totally inclusive, or limited in employee assignment or responsibilities. • PROVIDER & CROSS-FUNCTION COLLABORATION: • ∙ Acts as a liaison between coding staff, providers, CDI, billing, and revenue cycle leadership.
Benefits
• Competitive compensation • Medical, dental & vision plans, with an HSA/FSA option • 401(k) with employer match • Paid parental leave • Diana Health Culture • Having a growth mindset and striving for continuous learning and improvement • Positive, can do / how can I help attitude • Empathy for our team and our clients • Taking ownership and driving to results • Being scrappy and resourceful