- Professional
- Escritório em Wenatchee
Job Summary
The Coder’s primary job function is to certify accurate billing for professional services and hospital procedures. This is accomplished through review of clinical encounters, confirming correct use of diagnosis and procedural codes and application of appropriate modifiers and CCI edits. The Coder provides education to providers to ensure proper completion of the medical record.
Job Specific Competencies
1. Reviews clinical encounters presented via electronic lists to ensure proper submission of services prior to billing.
a. Edits and corrects diagnosis and procedural codes and applies modifiers and CCI edits as required according to coding guidelines and department policy.
b. Effectively utilizes coding software and/or books to confirm coding accuracy.
c. Verifies referring provider, rendering provider, department and other critical data elements are accurate prior to submission of completed coding.
2. Receives and reviews paper fee slips for hospital services and ensures proper coding of diagnosis and procedural codes.
a. Applies modifiers and CCI edits as required and supported by the documented medical record. Posts charges for final billing.
b. Verifies referring provider, rendering provider, department and other critical data elements are accurate prior to submission of completed coding.
3. Utilizing approved methods, communicates incorrect application of procedure or diagnosis codes or incomplete medical documentation to providers.
a. Reports all unresolved non-compliant coding issues immediately upon discovery, as dictated by department or organizational policy.
b. Works with providers and clinical support staff to resolve coding and documentation concerns.
4. Meets on a regular basis with providers and clinical staff (for their assigned specialties) for the purpose of educating them on coding rule changes and/or coding trends and to answer coding questions
a. Participates with educational activities with clinical departments, corporate compliance, etc. to ensure lines of communication among departments remains open and positive.
5. Is responsible to remain current with general billing guidelines, reimbursement rules and regulations.
a. Is responsible to remain current with their specific guidelines by reading payer publications and reviewing their websites.
b. Understands FQHC billing nuances to ensure accurate coding and maximum reimbursement for related services.
c. Attends conferences, seminars and webinars as requested to remain current on billing related policies.
6. Other responsibilities may include:
a. Provides information as needed for production reporting and to ensure job standards are consistently met or exceeded.
b. Assists with internal audits by providing requested information and participating in review finding discussions regarding insurance processing performance. Submits to remedial training if substandard performance is identified through such audits.
c. Assists co-workers and management with special projects related to claims or A/R clean- up efforts.
d. To ensure uninterrupted service, participates in cross-training efforts and provides coverage for insurance processing and follow-up needs with non-assigned payers.
e. Actively participates in departmental and/or organizational process improvement (lean) initiatives.
f. Notifies management of audit requests by insurance payers and complies with requests in a timely manner.
General Duties and Responsibilities
1. Performs other duties and tasks as assigned by supervisor.
2. Expected to meet attendance standards and work the hours necessary to perform the essential functions of the job.
3. Conforms to safety policies, general housekeeping practices.
4. Demonstrates sound work ethics, flexible, and shows dedication to the position and the community.
5. Demonstrates a positive attitude, is respectful, and possesses cultural awareness and sensitivity toward clients and co-workers.
6. Keeps customer service and the mission of the organization in mind when interacting with all clients, co-workers, and others.
7. Employees are expected to embrace, support and promote the core values of respect, integrity, trust, compassion and quality which align with the CVCH mission statement through their actions and interactions with all patients, staff, and others.
8. Conforms to CVCH policies and Joint Commission and HIPAA regulations.
Job Specifications
1. Education: High School Diploma or equivalent
2. Certification/Licensure: AAPC Certification (American Academy of Professional Coders).
3. Experience: One year of coding experience in a healthcare setting preferred. Strongly prefer knowledge of diagnosis and procedural coding, medical terminology and insurance billing guidelines, fluent with industry X12 and ANSI guidelines, proficient with claims adjustment reason and remark codes (CARC and RARC), FQHC certification or billing experience.
4. Language Skills: English required.
5. Essential Technical/Motor Skills: Knowledge of computer applications and equipment related to work. Must have basic computer and keyboarding skills and have the ability to enter data within company’s computer system to include strong knowledge in MS Word/Excel; must demonstrate manual dexterity. Exhibit strong customer service skills, strong process improvement background.
6. Interpersonal Skills: Strong interpersonal and communication skills and the ability to work effectively with other staff and management. Demonstrated skill in developing and maintaining productive work teams. Ability to demonstrate personal integrity in all interactions.
7. Essential Physical Requirements: This job is performed mostly in a typical inside, office environment. Essential physical requirements of this job include: light physical effort; repetitive motions of wrists, hands, and/or fingers; standing, walking, lifting, reaching, kneeling, bending, stooping, pushing, and pulling; frequent sitting; lifting and/or moving items up to 50 pounds, with assistance as needed; ability to read forms and computer screens and to read correspondence and other documents.
8. Essential Mental Abilities: Ability to make decisions in line with state and federal regulations; ability to read, comprehend, and analyze documents, regulations, and policies; ability to prepare and submit complete and succinct documents necessary to the job. Ability to assess and evaluate, have attention to detail. Knowledge of auditing and compliance procedures, quality assurance and improvement practices, understanding of the elements of sponsored clinical protocols including consent forms, and reporting requirements. Problem solving and analytical skills are required with a heavy emphasis on detailed analysis of information to support actions.
9. Essential Sensory Requirements: Essential sensory requirements include the ability to: read computer keyboard, monitor, and documents; prepare and analyze documents; read extensively; see, recognize, receive and convey detailed information orally, by telephone and in person; convey accurate and detailed instructions by speaking to others in person and by telephone.
10. Exposure to Hazards: Worker is subject to inside environmental conditions on a frequent basis with moderate noise. Typical working conditions found in most administrative work areas. Worker has contact with consumers and other staff and may be exposed to medical conditions presented by them.
Blood/Fluid Exposure Risk
Category III
1. Tasks involve no greater exposure to blood, body fluids, or tissues than would be encountered by a visitor. Category I tasks are not a condition of employment.
Age Specific Competency
Position does not involve patient care. Position will demonstrate general knowledge and skill to effectively communicate and provide safety measures to all life cycles.
Telecommuting
• Position eligible for Partial Telecommuting
Benefits
*Coverage below based on a 1.0 FTE; Medical, Dental, Paid Leave, Holidays are prorated based on FTE
Benefit: | Coverage: | Effective: |
Medical Premera (Self Insured) Preferred Provider | Employee covered - $60.00 per month Dependents covered – please refer to the benefits Guide 2025 for rates | First of the month following the first date of employment. |
Dental Washington Dental | Employee covered – 100% Dependents covered – 50% | First of the month following the first date of employment. |
Paid Leave | 120 hours – Year 1 136 hours - Year 2 | Paid Leave may be used immediately for sick leave and after 3 months employment for vacation. Maximum accrual cap of 320 hours; hours in excess of 320 hours will automatically transfer into the employees EIB. |
Extended Illness Bank (EIB) | Allows for maximum accrual of 200 hours | PTO hours in excess of 320 will transfer into EIB. Employees are eligible to use EIB hours after at least 3 consecutive scheduled working days of PTO (max 24 hours) which have been used for a personal illness and/or a qualifying event under FMLA or the WA Family Care Act. |
Holidays | 88 hours related to: · New Year’s Day · Memorial Day · 4th of July · Labor Day · Thanksgiving Day · Day after Thanksgiving · Christmas Eve · Christmas Day · 3 Diversity Days | Holidays are calculated as 8-hour days if full time, 1.0 FTE, and paid based on the calendar year (January 1 through December 31). Holiday hours will be added to the employee’s timecard automatically. If an employee is part-time, as documented in our HR/Payroll system, Holiday hours will be pro-rated. If an employee starts after the calendar year has begun, holiday hours will be prorated based on remaining holidays in the calendar year and diversity days will be prorated as outlined below: · Jan 1- April 30: 3 diversity days (24 hours if 1.0 FTE) · May 1 – August 31: 2 diversity days (16 hours if 1.0 FTE) · Sept 1 – Dec 31: 1 diversity day (8 hours if 1.0 FTE) Please refer to the Paid Leave policy for additional details. |
403(b) Retirement Plan Lincoln Financial | 150% CVCH match up to 3% of the employee’s contribution | Immediately. Vesting schedule: 20% at 2 years, 50% at 3 years, 60% at 4 years, and 100% at 5 years. |
Employee Assistance Program Mutual of Omaha | Free short-term counseling for employee and family | Immediately. Call 800-316-2796 |
Long-term Disability Mutual of Omaha | Employee Only (variable) | First of the month following the first date of employment. |
Benefit: | Coverage: | Effective: |
Basic Term Life Mutual of Omaha | Employee Only (1x annual salary, up to $200,000) | First of the month following the first date of employment. |
Group Accidental Death and Dismemberment (AD&D) Mutual of Omaha | Employee Only (1x annual salary, up to $200,000) | First of the month following the first date of employment. |
Supplemental Term Life Mutual of Omaha | Employee / Spouse / Dependent(s) | First of the month following the first date of employment. |
Voluntary AD&D Mutual of Omaha | Employee / Family | First of the month following the first date of employment. |
Health Reimbursement Arrangement RedQuote | Reimbursement for out of pocket expenses for services received at CVCH (medical, dental, and prescription) by employees and their dependents enrolled in our medical plan. Up to $750 per family per year. | First of the month following the first date of employment. |
Flex Plan: Medical RedQuote | Flex Plan: Maximum $3,300 per year Direct Deposit available | First of the month following the first date of employment. |
Flex Plan: Dependent Care RedQuote | Flex Plan: Maximum $5,000 per year Direct Deposit available | First of the month following the first date of employment. |
AFLAC | Supplemental insurance – cafeteria plan | First of the month following the first date of employment. |
Wellness Stipend | CVCH will reimburse staff up to $30 per month for a local gym membership OR CVCH will reimburse up to $150 per year for a subscription type workout program service (i.e.: Beachbody on Demand, Les Mills, etc.) | Immediately. Once employee has submitted invoice to HR/Payroll department. |
Cell Phone Discounts | Discounted monthly access fees Discounted select accessories and special equipment | Available for personal cell phones, currently in place with AT&T & Verizon |
Benefit: | Coverage: | Effective: |
Tuition Reimbursement | For approved courses, the cost of tuition, books, and lab fees may be reimbursed at 75% of the actual costs up to a maximum of: · $4,000 for an Associate’s degree, vocational, technical, or certification program · $6,000 for a Bachelor’s degree · $8,000 for a Master’s degree | Upon approval; regular employees who work at least 20 hours per week, have successfully passed their evaluation period and are in good standing may apply.
Employees must agree to work for a period of two (2) years from the date of receipt of tuition reimbursement and obtain satisfactory completion of approved courses or Challenge Exams. |
Compensation: $23.58-35.70/hourly (based on experience)
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